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At a Loss for Words, and for a Single Letter: ‘‘D’’

scale scores, and outscored those who obtained phototherapy (36% response, pB0.01). There was an inverse association between vitamin D level and result on the eight-question atypical Hamilton depression subscale (r20.26, p0.05). Forty-four Australian students (mean age22.0, age range 1843 years) without psychiatric disorders were given either 400 IU, 800 IU cholecalciferol or a placebo on 5 winter days.54 Subjects who took cholecalciferol had a significantly better improvement in the Positive and Negative Affect Schedule test than those who did not.

An epidemiological survey observed a relationship between vitamin D levels and the presence of depressive symptoms in the elderly. Among 2070 individuals aged at least 65 years who were part of a British national health survey, depressive symptoms were slightly more likely to occur in persons with severe vitamin D deficiency (B10 ng/mL) (OR 1.46; 95% CI 1.022.08) after adjustment for season, vitamin D intake, body mass index, chronic illness, age, socioeconomic status, and general health.

Other investigators have attempted to obtain additional evidence for the relationship between vitamin D and depres- sive symptoms from epidemiologic studies that compare cases in locations of different latitudes that vary in the amount of sunlight their populations receive. Overall, the results have not been conclusive.55 A number of investigations from Europe and North America observed a greater number of cases of seasonal affective disorder at latitudes farther from the Equator,5559 but others have not found a connection.55,6062 The inconclusive results may be the product of variations in sampling methods, daylight hours, humidity, heat, and cloud cover used in the different study locations. Another possibility is that light intensity (illuminance) accounts for the differ- ences in depressive symptoms by season more than total hours of daylight.63 Investigations originated in North America alone, when pooled, reveal an association between numbers of cases of seasonal affective disorder and distance from the Equator (r0.90, p0.003), but this does not occur in the rest of the world.55 Two other investigations have implied an association between vitamin D and depression.

In a sample of 75 subjects with fibromyalgia, larger scores

on symptom scales of depression and anxiety in individuals who had severely low vitamin D levels (B10 ng/mL).64 Vitamin D levels were contrasted between a population of seventeen persons with either depression or a bipolar disorder and another group of 861 normal individuals who resided in the same region of Australia.65,66 The healthy group had a significantly higher mean serum vitamin D concentration (32.4 ng/mL) than those mentally ill subjects (18.8 ng/mL).


At present the evidence for the relationship between vitamin D and cognition or depression lacks the results of randomized, controlled prospective trials.6769 Such trials are clearly needed to assess the possible role of vitamin D in the prevention or treatment of cognitive impairment.70 Although 19

several trials have conducted tests using vitamin D to ameliorate depressive symptoms, these have been limited to a small numbers of subjects, most of whom had seasonal disorders, using inadequate doses. Previously, I had advised that all elderly individuals be tested for vitamin D deficiency, and that all whose levels were B32 ng/mL be given 2000 IU cholecalciferol daily to confer other health benefits.71 Since then, several studies have suggested that a level of at least 40 ng/mL might reduce morbidity and mortality further.7276

The results of prospective trials of the use of vitamin D in

the treatment of dementia and depression have yet to be published. Therefore, it is unknown whether patients with depression and dementia require additional supplementation recommendations.

Disclosure: The author declares no conflict of interest.

REFERENCES 1. Anstey KJ, Low LF. Normal cognitive changes in aging. Aust Fam Physician. 2004;33(10):783787.

2. Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249265.

3. Dickstein DL, Walsh J, Brautigam H, Stockton SD, Jr., Gandy S, Hof PR. Role of vascular risk factors and vascular dysfunction in Alzheimer’s disease. Mt Sinai J Med. 2010;77(1):82102.

4. Querfurth HW, LaFerla FM. Alzheimer’s disease. N Engl J Med. 2010;362(4):329344.

5. Frisardi V, Solfrizzi V, Seripa D et al. Metabolic-cognitive syndrome: a cross-talk between metabolic syndrome and Alzheimer’s disease. Ageing Res Rev. [Epub ahead of print].

6. Obunai K, Jani S, Dangas GD. Cardiovascular morbidity and mortality of the metabolic syndrome. Med Clin North Am. 2007;91(6):11691184, x.

7. Kim JE, Chen J. Regulation of peroxisome proliferator-activated recep- torgamma activity by mammalian target of rapamycin and amino acids in adipogenesis. Diabetes. 2004;53(11):27482756.

8. Liang J, Fu M, Ciociola E, Chandalia M, Abate N. Role of ENPP1 on adipocyte maturation. PLoS One. 2007;2(9):882.

9. Blagosklonny MV. Aging and immortality: quasi-programmed senes- cence and its pharmacologic inhibition. Cell Cycle. 2006;5(18):20872102.

10. Silha JV, Krsek M, Sucharda P, Murphy LJ. Angiogenic factors are elevated in overweight and obese individuals. Int J Obes (Lond). 2005;29(11): 13081314.

11. Chou E, Suzuma I ,Way KJ et al. Decreased cardiac expression of vascular endothelial growth factor and its receptors in insulin-resistant and diabetic States: a possible explanation for impaired collateral formation in cardiac tissue. Circulation. 2002;105(3):373379.

12. Morishita R, Nakamura S, Hayashi S et al. Contribution of a vascular modulator, hepatocyte growth factor (HGF), to the pathogenesis of cardiovascular disease. J Atheroscler Thromb. 1998;4(3):128134.

13. Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Mol Cell Endocrinol. 2009;285(1):115122.

14. Vachharajani V, Granger DN. Adipose tissue: amotor for the inflamma- tion associated with obesity. IUBMB Life. 2009;61(4):424430.

15. Rosenstreich SJ, Rich C, Volwiler W. Deposition in and release of vitamin D3 from body fat: evidence for a storage site in the rat. J Clin Invest. 1971;50(3):679687.

16. Mawer EB, Backhouse J, Holman CA, Lumb GA, Stanbury SW. The distribution and storage of vitamin D and its metabolites in human tissues. Clin Sci. 1972;43(3):413431.

17. Backesjo CM, Li Y, Lindgren U, Haldosen LA. Activation of Sirt1 decreases adipocyte formation during osteoblast differentiation of mesenchymal stem cells. Cells Tissues Organs. 2009;189(14):9397.

18. Sergeev IN. 1,25-Dihydroxyvitamin D3 induces Ca2-mediated apoptosis in adipocytes via activation of calpain and caspase-12. Biochem Biophys Res Commun. 2009;384(1):1821.

M&B 2011; 2:(1). July 2011

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