title: Low vitamin D status does not adversely affect short-term functional outcome after total hip arthroplasty. Reproducibility of serum 25-hydroxyvitamin d and vitamin D-binding protein levels over time in a prospective cohort study of black and white adults. Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials An initial loading-dose vitamin D versus placebo after hip fracture surgery: baseline characteristics of a randomized controlled trial (REVITAHIP) Calcitriol Deficiency and 1-Year Mortality in Cardiac Transplant Recipients 1,25-Dihydroxyvitamin D fluctuations in cardiac surgery are related to age and clinical outcome* GRADE guidelines: 3. Rating the quality of evidence. The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery Changes in Vitamin D Status After Surgery in Female Patients With Lumbar Spinal Stenosis and Its Clinical Significance Association between preoperative 25-hydroxyvitamin D level and hospital-acquired infections following Roux-en-Y gastric bypass surgery. Impact of Anesthesia and Surgery for Congenital Heart Disease on the Vitamin D Status of Infants and Children: A Prospective Longitudinal Study Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Vitamin D status in neonates undergoing cardiac operations: relationship to cardiopulmonary bypass and association with outcomes. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. Evaluation of vitamin D level and grip strength recovery in women with a distal radius fracture. 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and postoperative outcome in cardiac surgery. Vitamin D status and outcomes after renal transplantation.
abstract: We prospect ively measured functional performances ( Western Ontario and McMaster Universities Osteoarthritis Index , Short Form-36 , 2-minute walk test , and timed get-up- and -go test ) of patients who underwent total hip arthroplasty ( THA )  and had serum vitamin D levels tested during the preoperative evaluation . Of 219 patients , 102 ( 46.6 % ) had low vitamin D levels ( 25-hydroxyvitamin D<30 ng/mL ) . Low vitamin D status did not adversely affect short-term function at 6 weeks after THA . In addition , there was no association between serum vitamin D levels and the within-patient changes of scores of each outcome measurement . Because this 6-week period is generally adequate to correct vitamin D deficiency , orthopedic surgeons can safely perform THA without delay . Nevertheless , because vitamin D deficiency impairs bone quality , patients with low vitamin D levels should be treated once identified Prospect i ve epidemiologic studies generally rely on 1 baseline biologic sample from participants for measurement of prediagnostic biomarkers , assuming that 1 measurement adequately represents the participant 's " typical " level . The body of work assessing the reproducibility of circulating serum 25-hydroxyvitamin D ( 25(OH)D ) levels over time focuses almost exclusively on population s of European descent , and data for vitamin D-binding protein ( VDBP ) are virtually nonexistent . Thus , the authors measured levels of serum 25(OH)D and VDBP twice in sample s collected between 2005 and 2008 from 225 participants ( 155 black , 70 white ) in the Southern Community Cohort Study .  Reproducibility for 25(OH)D was uniformly high , with adjusted intraclass correlation coefficients ( ICCs ) of 0.84 ( 95 % confidence interval ( CI ) : 0.79 , 0.88 ) for blacks and 0.92 ( 95 % CI : 0.87 , 0.95 ) for whites , and there was substantial agreement for assignment of 25(OH)D quartile ( κ = 0.83 , 95 % CI : 0.78 , 0.87 ) and vitamin D adequacy status ( κ = 0.76 , 95 % CI : 0.69 , 0.83 ) . VDBP levels were highly stable over time , with adjusted ICCs of 0.97 ( 95 % CI : 0.96 , 0.98 ) for blacks and 0.96 ( 95 % CI : 0.93 , 0.97 ) for whites . These findings suggest that single , baseline 25(OH)D and VDBP serum measurements provide reasonably representative measures of these compounds for both white and black adults , demonstrating their utility as epidemiologic biomarkers in prospect i ve studies AIMS A significant proportion of cardiac surgical patients develop critical post-operative complications . We aim ed to investigate the association of pre-operative 25-hydroxyvitamin D ( 25(OH)D ) levels with major cardiac and cerebrovascular events ( MACCE ) in cardiac surgical patients . METHODS AND RESULTS From January 2010 to August 2011 , we consecutively measured circulating 25(OH)D in 4418 operated patients . Of the study cohort , 38.0 % had deficient 25(OH)D values ( < 30 nmol/L ) and additional 32.3 % had insufficient values ( 30 - 49.9 nmol/L ) , whereas only 3.1 % had values > 100 nmol/L. The incidence of MACCE was 11.5 % . In multivariable-adjusted logistic regression models , the odds ratio of MACCE at deficient , inadequate , and high 25(OH)D levels was 2.23 [ 95 % confidence interval ( CI ) : 1.31 - 3.79 ] , 1.73 ( 95 % CI : 1.01 - 2.96 ) and 2.34 ( 95 % CI : 1.12 - 4.89 ) , respectively , compared with 25(OH)D levels of 75 - 100 nmol/L. A U-shaped association with circulating 25(OH)D was also present for duration of mechanical ventilatory support and intensive care unit stay . Multivariable-adjusted 6- and 12-month mortality were higher in patients with deficient 25(OH)D levels compared with patients with 25(OH)D levels of 75 - 100 nmol/L. CONCLUSION Deficient 25(OH)D levels are prevalent in cardiac surgical patients in Central Europe and are independently associated with the risk of MACCE . Further research should clarify the potential of vitamin D supplements in reducing cardiovascular risk in vitamin D-deficient patients and also the mechanisms leading to adverse effects on the cardiovascular system in the small group of patients with 25(OH)D levels > 100 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Hypovitaminosis D is particularly common among older people with a proximal femoral ( hip ) fracture . There are currently no agreed strategies for vitamin D replenishment after hip fracture surgery . The REVITAHIP Study is a multisite , double-blinded r and omized-controlled trial investigating the effects of an oral vitamin D loading dose on gait velocity after hip fracture surgery . We describe the baseline characteristics of participants , aim ing to document hypovitaminosis D and its associations after hip fracture . Methods Participants , over 65 , recruited within 7 days following hip fracture surgery from 3 Australia hospitals , were r and omly allocated to receive a loading dose of vitamin D3 ( 250,000IU ) or placebo , followed by oral maintenance vitamin D3/calcium ( 800 IU/500 mg ) and the usual hip fracture rehabilitation pathway . Demographic and clinical data were collected , including surgical procedure , pre-fracture functional status , Mini Mental State Examination ( MMSE ) score , serum 25-hydroxyvitamin D ( 25-OHD ) , Verbal Rating Scale ( VRS ) for pain , grip strength and gait velocity . The associations of baseline 25-OHD levels with demographic and clinical data were assessed using Pearson ’s correlation , ANOVA and regression analyses . Results Two-hundred- and -eighteen people with hip fracture participated in the study . Mean age was 83.9+/-7.2 years , 77 % were women and 82 % lived in private homes . Fifty-six percent had a subcapital fracture . Mean comorbidity count was 3.13+/-2.0 . Mean MMSE was 26.1+/-3.9 . Forty-seven percent of participants had hypovitaminosis D ( < 50 nmol/L ) . Multivariate regression models demonstrated higher baseline vitamin D levels were significantly associated with higher premorbid Barthel index scores , lower post-operative VRS pain levels and use of vitamin D. Conclusion This study cohort shared similar demographic characteristics and comorbidities with other cohorts of people with hip fracture , with the probable exception of less cognitive impairment . Hypovitaminosis D was not as prevalent as previously documented . Patients taking vitamin D supplements and with higher premorbid Barthel index , reflecting greater independence and activity , tended to have higher 25-OHD levels at baseline . Further , lower VRS pain ratings following surgery were associated with higher vitamin D levels . Such associations will need further investigation to determine causation . ( ANZCTR number , ACTRN12610000392066).Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ANZCTRN ACTRN12610000392066 Background . Administration of the vitamin D hormone calcitriol improves survival in solid-organ transplanted experimental animals . We investigated whether lower serum calcitriol concentrations are associated with increased 1-year mortality in cardiac transplant recipients . Methods . We prospect ively recruited 171 patients who underwent cardiac transplantation at out institution between May 2004 and April 2006 . We assessed  calciotropic hormones , inflammation markers , and renal function preoperatively and on postoperative days 6 ( t1 ) and 21 ( t2 ) . Results . Serum creatinine and C-reactive protein increased , whereas calcitriol decreased significantly after transplantation ( P<0.001 ) . As determined by multivariable Cox regression analysis , the calcitriol level at t2 was an independent predictor of 1-year mortality . One-year mortality was 3.7 per 100 person-years in the tertile with the highest calcitriol concentrations at t2 ( > 18 pg/mL ) , 13.2 per 100 person-years in the intermediate tertile ( 11–18 pg/mL ) , and 32.1 per 100 person-years in the tertile with the lowest calcitriol concentrations at t2 ( < 11 pg/mL ) ( P<0.001 ) .  25-hydroxyvitamin D deficiency ( serum concentrations below 10 ng/mL ) , renal insufficiency ( serum creatinine ≥1.6 mg/dL ) , and high serum concentrations of the inflammation markers C-reactive peptide and tumor necrosis factor-&agr ; were predictors of a serum calcitriol concentration below 11 pg/mL ( P=0.037–0.001 ) . Conclusions . Low postoperative calcitriol concentrations are independently associated with high 1-year mortality in cardiac transplant recipients . A causal relationship has yet to be proven by intervention trials using active vitamin Objective : To investigate the interrelationship between cardiac surgery , age , circulating concentrations of the vitamin D hormone 1,25-dihydroxyvitamin D , and clinical outcome . Design : Prospect i ve , monocentric , two-arm parallel study . Setting : Tertiary Heart and Diabetes Center in the Federal State of North Rhine-Westphalia , Germany . Patients : Twenty-nine cardiac surgical patients aged ⩽65 yrs and 30 patients ≥75 yrs . Measurements : We assessed  1,25-dihydroxyvitamin D and other biochemical parameters of mineral metabolism ( calcium , phosphate , 25-hydroxyvitamin D , and parathyroid hormone ) , various inflammatory markers ( C-reactive protein , interleukin-6 and 8) , and different immunological parameters ( CD4 and CD8 cells , monocyte HLA-DR expression ) . We collected blood sample s preoperatively , immediately after surgery , and on postoperative days 1 , 5 , and 30 . In addition , we assessed adverse outcome until discharge as a composite of myocardial infa rct ion , low cardiac output syndrome , infection , stroke , or in-hospital death . Results : There were significant transient cardiac surgery-related fluctuations in 1,25-dihydroxyvitamin D and the aforementioned parameters of mineral metabolism , inflammation , and immune status . Compared to younger patients , older patients had consistently lower 1,25-dihydroxyvitamin D and phosphate levels ( p = .013 and p = .036 , respectively ) and significantly higher interleukin 6 and 8 levels ( p = .008 and p < .001 , respectively ) . Circulating 1,25-dihydroxyvitamin D was directly related to glomerular filtration rate ( R2 = .227 ; p < .001 ) and inversely related to interleukin 6 ( R2 = .105 ; p = .012 ) . The rate of adverse outcome tended to be higher in older than in younger patients ( 20.0 % vs. 3.5 % ; p = .081 ) . In risk score-adjusted logistic regression analysis , adverse outcome risk decreased by 7.7 % ( SE : 3.7 % ) for each pmol/L increment in 1,25-dihydroxyvitamin D ( p = .037 ) . Conclusions : Circulating 1,25-dihydroxyvitamin D levels fluctuate in relation to cardiac surgery . Low 1,25-dihydroxyvitamin D levels are associated with inflammatory processes and age-related differences in clinical outcome . Future studies should determine whether therapies aim ed at treating low 1,25-dihydroxyvitamin D levels can improve the outcome in older cardiac surgery patients This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence BACKGROUND : Vitamin D deficiency is a global health problem . Epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective . Vitamin D also plays a substantial role in innate and acquired immunity . Our goal was to evaluate the association of serum vitamin D concentration on serious postoperative complications and death in noncardiac surgical patients . METHODS : We retrospectively analyzed the data of 3509 patients who had noncardiac surgery at the Clevel and Clinic Main Campus and had a serum vitamin D measurement . The relationship between serum vitamin D concentration and all-cause in-hospital mortality , in-hospital cardiovascular morbidity , and serious in-hospital infections was assessed as a common effect odds ratio ( OR ) by using a multivariate generalized estimating equation model with adjustment for demographic , medical history variables , and type and duration of surgery . RESULTS : Higher vitamin D concentrations were associated with decreased odds of in-hospital mortality/morbidity ( P = 0.003 ) . There was a linear reduction of the corresponding common effect odds ratio ( OR 0.93 , 95 % confidence interval , 0.88–0.97 ) for severe in-hospital outcomes for each 5 ng/mL increase in vitamin D concentration over the range from 4 to 44 ng/mL. In addition , we found that the odds versus patients  with vitamin D < 13 ng/mL ( i.e. , 1st quintile ) were significantly lower in patients with vitamin D 13–20 , 20–27 , 27–36 , and > 36 ng/mL ( i.e. , 2nd–5th quintiles ) ; the corresponding estimated ORs were 0.65 ( 99 % confidence interval , 0.43–0.98 ) , 0.53 ( 0.35–0.80 ) , 0.44 ( 0.28–0.70 ) , and 0.49 ( 0.31–0.78 ) , respectively . However , there was no statistically significant difference among individual quintiles > 13 ng/mL. CONCLUSIONS : Vitamin D concentrations were associated with a composite of in-hospital death , serious infections , and serious cardiovascular events in patients recovering from noncardiac surgery . While causality can not be determined from our retrospective analysis , the association suggests that a large r and omized trial of preoperative vitamin D supplementation and postoperative outcomes is warranted Study Design . A prospect i ve cohort study . Objective . To demonstrate the changes in vitamin D status after surgery in female patients with lumbar spinal stenosis ( LSS ) , and its correlation with surgical outcomes . Summary of Background Data . In patients with LSS , general health including walking ability and nutritional status can be markedly improved by decompressive surgery . It can be hypothesized that such improvement may have a positive effect on their vitamin D status . Methods . In total , 31 female patients who underwent decompression and instrumented posterolateral fusion for LSS were enrolled .  Serum 25-hydroxyvitamin D ( 25-OHD ) level  was measured before the surgery and at 1 year postoperative visit . According to serum 25-OHD level , patients were classified into 3 groups : ( 1 ) deficient group , when 25-OHD level was less than 20 ng/mL ( < 50 nmol/L ) ; ( 2 ) insufficient group , when 25-OHD level was between 20 to 30 ng/mL ( 50 nmol/L ⩽ 25-OHD < 75 nmol/L ) ; ( 3 ) and normal group , when 25-OHD level was 30 ng/mL or more ( ≥75 nmol/L ) . The Oswestry Disability Index ( ODI ) score and health-related quality of life ( EQ-5D ) were compared according to the level of 25-OHD at 1 year postoperatively . Results . Preoperatively , there were 20 patients in the deficient group , 11 patients in the insufficient group and no patient in the normal group . There were no differences in age , body mass index , preoperative ODI scores , preoperative EQ-5D index scores , and EQ-5D visual analogue scale scores between the 2 groups . Mean preoperative 25-OHD level was 15.8 ng/mL ( range , 5.2–29.4 ng/mL ) and increased to 19.5 ng/mL ( range , 6.3–47.7 ng/mL ) 1 year after surgery ( P = 0.075 ) . Significant increase of 25-OHD was noted only in the deficient group ( P = 0.017 ) . Postoperatively , there were 18 patients in the deficient group , 8 patients in the insufficient group , and 5 patients in the normal group . In the postoperative deficient group , postoperative ODI scores and EQ-5D index scores showed significantly worse outcomes than those in the other groups . The changes in serum 25-OHD level were significantly correlated with the changes in ODI scores ( r = −0.580 ; P = 0.001 ) and with the changes in EQ-5D index scores ( r = 0.379 ; P = 0.035 ) . In all the groups , postoperative ODI scores ( r = −0.665 ; P < 0.001 ) and EQ-5D index scores ( r = 0.601 ; P < 0.001 ) were significantly correlated with postoperative 25-OHD level . Conclusion .  Vitamin D deficiency was common in patients with LSS . However , vitamin D status was improved after decompressive surgery , and postoperative 25-OHD level was significantly correlated with surgical outcomes IMPORTANCE Postoperative hospital-acquired infections ( HAIs ) may result from disruption of natural barrier sites . Recent studies have linked vitamin D status and barrier site integrity . OBJECTIVE To investigate the association between preoperative vitamin D status and the risk for HAIs . DESIGN , SETTING , AND PARTICIPANTS A retrospective analysis was performed using propensity score methods to construct a matched-pairs cohort to reduce baseline differences between patients with 25-hydroxyvitamin D ( 25[OH]D ) levels less than 30 ng/mL vs 30 ng/mL or greater .  Multivariable logistic regression analysis was then performed to examine the association between 25(OH)D levels and HAIs while adjusting for additional perioperative factors . Locally weighted scatterplot smoothing was used to depict the relationship between increasing 25(OH)D levels and the risk for HAIs . This study was conducted in a single , teaching hospital in Boston , Massachusetts , and involved 770 gastric bypass surgery patients between January 1 , 2007 , and December 31 , 2011 . EXPOSURES Preoperative 25(OH)D levels . MAIN OUTCOMES AND MEASURES Association between preoperative 25(OH)D levels and the risk for postoperative HAIs . RESULTS The risk for HAIs was 3-fold greater ( adjusted odds ratio , 3.05 ; 95 % CI , 1.34 - 6.94 ) in patients with 25(OH)D levels less than 30 ng/mL vs 30 ng/mL or greater . Further adjustment for additional perioperative factors did not material ly change this association . Locally weighted scatterplot smoothing analysis depicted a near inverse linear relationship between vitamin D status and the risk for HAIs for 25(OH)D levels around 30 ng/mL. CONCLUSIONS AND RELEVANCE In our patient cohort , a significant inverse association was observed between preoperative 25(OH)D levels and the risk for HAIs . These results suggest that preoperative 25(OH)D levels may be a modifiable risk factor for postoperative nosocomial infections . Prospect i ve studies must determine whether there is a potential benefit to preoperative optimization of vitamin D status Background : Vitamin D is recognized as a pleiotropic hormone important for the functioning of organ systems , including those central to critical illness pathophysiology . Recent studies have reported associations between vitamin D status and outcome among critically ill adults and children . Preoperative vitamin D status , impact of operative techniques , and relationship between immediate postoperative vitamin D levels and clinical course have not been described in the pediatric congenital heart disease ( CHD ) population . The objective of this study was to describe the impact of CHD surgery on vitamin D status and relationship between postoperative levels and clinical course . Methods : A prospect i ve cohort study was conducted from 2009 to 2011 at a single tertiary care pediatric hospital . A total of 58 children with CHD were enrolled and  blood collected preoperatively , intraoperatively , and postoperatively .  Serum 25-hydroxyvitamin D ( 25OHD ) was measured using liquid chromatography – mass spectrometry . Results : The mean preoperative 25OHD was 58.0 nM ( SD , 22.4 ) , with 42 % being deficient ( < 50 nM ) . Postoperatively , we identified a 40 % decline in 25OHD to 34.2 nM ( SD , 14.5 ) with 86 % being deficient . Intraoperative measurements determined that initiation of cardiopulmonary bypass coincided with abrupt decline . CHD patients requiring catecholamines had lower postoperative 25OHD ( 38.2 vs. 26.5 nM , P = 0.007 ) , findings confirmed through multivariate logistic regression . Lower postoperative 25OHD was associated with increased fluid requirements and intubation duration . Conclusions : Most CHD patients are vitamin-D deficient postoperatively due to low preoperative levels and a significant intraoperative decline . Interventional studies will be required to determine whether prevention of postoperative vitamin D deficiency improves outcome BACKGROUND A high prevalence ( 60 % ) of vitamin D ( VitD ) depletion , defined as a serum 25-hydroxyvitamin D level of < or = 20 ng/mL , is present in preoperative morbidly obese patients . Despite daily supplementation with 800 IU VitD and 1500 mg calcium after Roux-en-Y gastric bypass ( RYGB ) , VitD depletion persists in almost one half ( 44 % ) of patients . However , the optimal management of VitD depletion after RYGB and the potential benefits of such treatment are currently unknown . METHODS A total of 60 VitD-depleted morbidly obese women were r and omly assigned to receive 50,000 IU of VitD weekly after RYGB ( group 1 ; n = 30 ) or no additional VitD after RYGB ( group 2 ; n = 30 ) . All patients received a daily supplement of 800 IU VitD and 1500 mg calcium . The serum calcium , parathyroid hormone , 25-hydroxyvitamin D , bone-specific alkaline phosphatase , urinary N-telopeptide , and bone mineral density were measured preoperatively and 1 year after RYGB . Question naires were used to assess other potential sources of VitD , including sunlight exposure and ingestion of VitD-containing foods/liquids . RESULTS At 1 year after RYGB , VitD depletion and mean 25-hydroxyvitamin D level had improved significantly in group 1 ( 14 % and 37.8 ng/mL , respectively ) compared with the values in group 2 ( 85 % and 15.2 ng/mL , respectively ; P < .001 for both ) . A significant 33 % retardation in hip bone mineral density decline ( P = .043 ) and a significantly greater resolution of hypertension was seen in group 1 ( 75 % versus 32 % ; P = .029 ) . No significant adverse effects were encountered from pharmacologic VitD therapy . CONCLUSION The results of our study have shown that 50,000 IU of VitD weekly after RYGB safely corrects VitD depletion in most women , attenuates cortical bone loss , and improves resolution of hypertension OBJECTIVES To determine the incidence of vitamin D deficiency in neonates with congenital heart disease and whether differences exist by race . In addition , we determined the effect of cardiopulmonary bypass on vitamin D levels and explored associations between 25-hydroxyvitamin D [ 25(OH)D ] levels and postoperative outcomes . STUDY DESIGN We performed a secondary analysis of a prospect i ve r and omized controlled trial in 70 neonates undergoing cardiac surgery .  The neonates ' 25(OH)D levels were measured in the operating room before skin incision ( baseline ) , at the cessation of cardiopulmonary bypass , and at 24 hours postoperatively . Associations between these levels and clinical outcomes were explored . Vitamin D deficiency was defined as a 25(OH)D level < 20 ng/mL. RESULTS  Vitamin D deficiency was present in 84 % ( 59/70 ) ; concentrations in African Americans ( n = 20 ) were significantly lower than those of Caucasian/other race/ethnicity ( n = 50 ) ( 10.2 ± 4.2 vs 16.0 ± 5.6 ng/mL , P < .0001 ) . The 24-hour postoperative 25(OH)D levels were not different from baseline and correlated with a reduced postoperative inotropic requirement ( r = -0.316 , P = .008 ) . CONCLUSIONS Vitamin D deficiency is prevalent in neonates with congenital cardiac defects , and lower postoperative 25(OH)D levels are associated with the need for increased inotropic support in neonates undergoing cardiac operations . These findings support that vitamin D deficiency may play a role in myocardial injury and postoperative recovery and warrants further investigation This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine ( IOM ) . An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes . The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health , consistent with a cause- and -effect relationship and providing a sound basis for determination of intake requirements . For extraskeletal outcomes , including cancer , cardiovascular disease , diabetes , and autoimmune disorders , the evidence was inconsistent , inconclusive as to causality , and insufficient to inform nutritional requirements . R and omized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative . Based on bone health , Recommended Dietary Allowances ( RDAs ; covering requirements of ≥97.5 % of the population ) for calcium range from 700 to 1300 mg/d for life-stage groups at least 1 yr of age . For vitamin D , RDAs of 600 IU/d for ages 1–70 yr and 800 IU/d for ages 71 yr and older , corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml ( 50 nmol/liter ) , meet the requirements of at least 97.5 % of the population . RDAs for vitamin D were derived based on conditions of minimal sun exposure due to wide variability in vitamin D synthesis from ultraviolet light and the risks of skin cancer . Higher values were not consistently associated with greater benefit , and for some outcomes U-shaped associations were observed , with risks at both low and high levels . The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated . Urgent research and clinical priorities were identified , including re assessment of laboratory ranges for 25-hydroxyvitamin D , to avoid problems of both undertreatment and overtreatment IMPORTANCE Low vitamin D status is linked to increased mortality and morbidity in patients who are critically ill . It is unknown if this association is causal . OBJECTIVE To investigate whether a vitamin D3 treatment regimen intended to restore and maintain normal vitamin D status over 6 months is of health benefit for patients in ICUs . DESIGN , SETTING , AND PARTICIPANTS A r and omized double-blind , placebo-controlled , single-center trial , conducted from May 2010 through September 2012 at 5 ICUs that included a medical and surgical population of 492 critically ill adult white patients with vitamin D deficiency ( ≤20 ng/mL ) assigned to receive either vitamin D3 ( n = 249 ) or a placebo ( n = 243 ) . INTERVENTIONS Vitamin D3 or placebo was given orally or via nasogastric tube once at a dose of 540,000 IU followed by monthly maintenance doses of 90,000 IU for 5 months . MAIN OUTCOMES AND MEASURES The primary outcome was hospital length of stay . Secondary outcomes included , among others , length of ICU stay , the percentage of patients with 25-hydroxyvitamin D levels higher than 30 ng/mL at day 7 , hospital mortality , and 6-month mortality . A predefined severe vitamin D deficiency ( ≤12 ng/mL ) subgroup analysis was specified before data unblinding and analysis . RESULTS A total of 475 patients were included in the final analysis ( 237 in the vitamin D3 group and 238 in the placebo  group ) . The median ( IQR ) length of hospital stay was not significantly different between groups ( 20.1 days [ IQR , 11.1 - 33.3 ] for vitamin D3 vs 19.3 days [ IQR , 11.1 - 34.9 ] for placebo ; P = .98 ) . Hospital mortality and 6-month mortality were also not significantly different ( hospital mortality : 28.3 % [ 95 % CI , 22.6%-34.5 % ] for vitamin D3 vs 35.3 % [ 95 % CI , 29.2%-41.7 % ] for placebo ; hazard ratio [ HR ] , 0.81 [ 95 % CI , 0.58 - 1.11 ] ; P = .18 ; 6-month mortality : 35.0 % [ 95 % CI , 29.0%-41.5 % ] for vitamin D3 vs 42.9 % [ 95 % CI , 36.5%-49.4 % ] for placebo ; HR , 0.78 [ 95 % CI , 0.58 - 1.04 ] ; P = .09 ) . For the severe vitamin D deficiency subgroup analysis ( n = 200 ) , length of hospital stay was not significantly different between the 2 study groups : 20.1 days ( IQR , 12.9 - 39.1 ) for vitamin D3 vs 19.0 days ( IQR , 11.6 - 33.8 ) for placebo . Hospital mortality was significantly lower with 28 deaths among 98 patients ( 28.6 % [ 95 % CI , 19.9%-38.6 % ] ) for vitamin D3 compared with 47 deaths among 102 patients ( 46.1 % [ 95 % CI , 36.2%-56.2 % ] ) for placebo ( HR , 0.56 [ 95 % CI , 0.35 - 0.90 ] , P for interaction = .04 ) , but not 6-month mortality ( 34.7 % [ 95 % CI , 25.4%-45.0 % ] for vitamin D3 vs 50.0 % [ 95 % CI , 39.9%-60.1 % ] for placebo ; HR , 0.60 [ 95 % CI , 0.39 - 0.93 ] , P for interaction = .12 ) . CONCLUSIONS AND RELEVANCE Among critically ill patients with vitamin D deficiency , administration of high-dose vitamin D3 compared with placebo did not reduce hospital length of stay , hospital mortality , or 6-month mortality . Lower hospital mortality was observed in the severe vitamin D deficiency subgroup , but this finding should be considered hypothesis generating and requires further study . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01130181 PURPOSE Vitamin D is known to contribute to muscular function . The purpose of this study was to determine whether the level of vitamin D is associated with grip strength recovery in women after a distal radius fracture . METHODS We analyzed grip strength recovery after a distal radius fracture in 70 women over age 50 years . We measured vitamin D levels and grip strength recovery , which we analyzed as a function of age , surgical care , baseline vitamin D level , vitamin D supplementation , wrist range of motion , pain level , and radiographic results at 6 months . We performed multivariate analysis to identify factors that independently predicted grip strength recovery at 6 months after injury . RESULTS Grip strength of affected h and s averaged 65 % of the contralateral sides ( range , 25 % to 100 % ) at 6 months after injury . We found no significant correlation between baseline vitamin D level and grip strength recovery . However , baseline vitamin D level correlated with the grip strengths of uninjured sides . Multivariate analysis indicated that younger age , vitamin D supplementation , and greater wrist range of motion were independently associated with better grip strength recovery at 6 months after injury . CONCLUSIONS This study demonstrated that in women with a distal radius fracture , baseline vitamin D level is not associated with grip strength recovery in the injured h and . However , baseline vitamin D level correlated with grip strength in the uninjured h and . In addition , vitamin D supplementation may help grip strength recovery in the injured h and . Further prospect i ve , comparative studies are warranted to confirm the effect of vitamin D supplementation on grip strength recovery CONTEXT Several cohort studies have reported U-shaped or inverse J-shaped associations between circulating 25-hydroxyvitamin D [ 25OHD ] and clinical outcomes . OBJECTIVE We aim ed to investigate in cardiac surgical patients the association of preoperative 25OHD and 1,25-dihydroxyvitamin D3 [ 1,25(OH)2D3 ] levels with the risk of major adverse cardiac and cerebrovascular events ( MACCE ) . DESIGN A prospect i ve cohort study of adult cardiac surgical patients in 2012 - 2013 was used . SETTING The study was conducted at the Heart and Diabetes Center North Rhine-Westphalia , Germany . PATIENTS A total of 3371 adult patients participated in the study . INTERVENTION None Measurements : The main outcome measure was MACCE until discharge . We categorized vitamin D metabolite levels into subgroups and performed multivariable-adjusted logistic regression analysis to estimate odds ratios ( ORs ) of MACCE . Moreover , we performed multiple regression analysis to assess the association of 25OHD and circulating 1,25(OH)2D3 with preoperative parameters . RESULTS As compared with patients in the 25OHD reference category ( 75 - 100 nmol/L ) , the multivariable-adjusted odds ratios ( OR ) of MACCE was significantly higher in patients with deficient 25OHD levels ( < 30 nmol/L ) ( OR = 2.06 [ 95%CI : 1.24 - 3.43 ] ) , but was comparable in patients with 25OHD levels > 100 nmol/L ( OR = 1.16 [ 95 % CI : 0.56 - 2.37 ] ) . Poor kidney function was an important predictor of high 25OHD ( > 100 nmol/L ) and low 1,25(OH)2D3 levels . 1,25(OH)2D3 was not independently associated with the incidence of MACCE . CONCLUSIONS In cardiac surgical patients , deficient but not high 25OHD levels are independently associated with the risk of MACCE . Cohort studies should consider potential interrelationships between kidney function , circulating vitamin D metabolite levels , and clinical outcome Kidney transplant recipients usually have low vitamin D levels , especially in the early posttransplantation period , but the association between vitamin D status with renal outcomes is not well described in this population . Here , we studied a prospect i ve cohort of 634 kidney recipients who underwent transplantation at a single institution between January 2005 and June 2010 . In this cohort , low 25-hydroxyvitamin D concentrations 3 months after transplantation did not predict early death or graft loss but were independently associated with lower measured GFR at 12 months ( P=0.001 ) and higher risk for interstitial fibrosis and tubular atrophy ( P=0.01 ) . In contrast , levels of calcium , phosphorus , calcitriol , parathyroid hormone , or fibroblast growth factor-23 were not consistently associated with any of the studied outcomes . In conclusion , low  25-hydroxyvitamin D concentration measured 3 months after transplantation is an independent risk factor for interstitial fibrosis progression and is associated with a lower GFR 1 year after transplantation
target: In conclusion , this review supports the hypothesis that hypovitaminosis D is associated with adverse outcomes after diverse surgical procedures .
background: The importance of vitamin D for musculoskeletal health has long been recognized , and awareness of significant extra-skeletal effects in health and disease is rapidly emerging .
  Although it has been possible for many decades to quantify serum markers of vitamin D deficiency , and to correct deficiency at low cost and with high safety , the influence of vitamin D status on post-surgical outcomes has only recently been identified as a research topic of interest .
  To the present , these data have not been the subject matter of formal review .
  Accordingly , we conducted a systematic review to assess the association between perioperative vitamin D status and outcomes after surgery .