Special Issue "The Close Relationship: Health and Nutrition"


A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 15 March 2015

Special Issue Editors

Guest Editor
Prof. Samir Samman
Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand
Website: http://sydney.edu.au/medicine/people/academics/profiles/ssamman.php
E-Mail: samir.samman@otago.ac.nz
Phone: +64 3 479 7945
Interests: nutritional science; vitamins; minerals; zinc; biomarkers; chronic disease

Guest Editor
Prof. Ian Darnton-Hill AO
The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, K25-Medical Foundation Building K25, The University of Sydney, NSW 2006, Australia
Website: http://sydney.edu.au/medicine/people/academics/profiles/idarntonhill.php#themes
E-Mail: iandarntonhill@aol.com
Interests: public health nutrition; global health and nutrition policy; double burden of malnutrition

Special Issue Information

Dear Colleagues,

Health is inextricably linked to nutrition. An unbalanced diet, whether deficient in one or more nutrients or excessive intakes of macronutrients, contribute to many physical and mental disorders. Whether people are healthy or not, is determined by their lifestyles, genetic predisposition and the environment, especially their nutrition. Diet-related factors that affect the health of individuals include access to an adequate and safe food supply, consuming a balanced diet, keeping active, and drinking alcohol in moderation, and others more subtle in their effects. How we deal with stress also affects health. This special issue of Healthcare examines “the close relationship: health and nutrition” and aims to bring together recent findings in this field. Previously unpublished articles that describe research in diverse populations are invited and welcome.

Prof. Samir Samman
Prof. Ian Darnton-Hill AO
Guest Editors


Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed Open Access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. For the first couple of issues the Article Processing Charge (APC) will be waived for well-prepared manuscripts. English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.


  • micronutrients
  • macronutrients
  • dietary patterns
  • food security
  • food safety

Published Papers (6 papers)

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Displaying article 1-6
p. 3-19
by  and
Healthcare 2015, 3(1), 3-19; doi:10.3390/healthcare3010003
Received: 30 October 2014 / Accepted: 31 December 2014 / Published: 9 January 2015
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(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
p. 505-515
Healthcare 2014, 2(4), 505-515; doi:10.3390/healthcare2040505
Received: 12 August 2014 / Revised: 2 December 2014 / Accepted: 11 December 2014 / Published: 18 December 2014
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(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
p. 468-491
Healthcare 2014, 2(4), 468-491; doi:10.3390/healthcare2040468
Received: 28 July 2014 / Revised: 14 October 2014 / Accepted: 10 November 2014 / Published: 21 November 2014
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(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
p. 429-444
Healthcare 2014, 2(4), 429-444; doi:10.3390/healthcare2040429
Received: 17 May 2014 / Revised: 18 September 2014 / Accepted: 13 October 2014 / Published: 23 October 2014
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(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
p. 282-298
by , , , , , , , ,  and
Healthcare 2014, 2(3), 282-298; doi:10.3390/healthcare2030282
Received: 5 February 2014 / Revised: 21 June 2014 / Accepted: 3 July 2014 / Published: 23 July 2014
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(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
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p. 207-219
by , , ,  and
Healthcare 2014, 2(2), 207-219; doi:10.3390/healthcare2020207
Received: 12 February 2014 / Revised: 1 April 2014 / Accepted: 2 April 2014 / Published: 28 April 2014
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Type of Paper: Article
Telehealth Coaching to Promote Bone Health and Nutrition in Deployed Soldiers
Mary S. McCarthy
Center for Nursing Science & Clinical Inquiry, Madigan Army Medical Center, Tacoma, WA 98388, USA; E-Mail: mary.s.mccarthy1.civ@mail.mil
The purpose of this study was to determine if telehealth coaching is superior to one-time nutrition and fitness education regarding: a) dietary contributions to bone health, and b) exercise contributions to bone health, assessed before and after deployment. Young service men and women are returning from war with significant physical injuries, as well as “wear and tear” from long work hours, heavy body armor, and alterations in diet and exercise behaviors. This is the second in a series of studies examining the impact of deployment specifically on bone health and nutrition. Previous findings have demonstrated that inadequate consumption of calcium and vitamin D and a decrease in exercise while deployed can be detrimental to bone health. This prospective, longitudinal, cluster-randomized, controlled trial enrolled 234 Soldiers at baseline; 155 returned from deployment with 85 in the telehealth group and 70 in the control group, yielding a 34% attrition rate. All Soldiers received a nutrition and bone health class prior to deployment; Soldiers randomized to the telehealth intervention group received on-demand health-related messages via electronic mail platforms. Baseline 25(OH) vitamin D revealed a high rate of insufficiency (61%, level < 30 ng/mL) and moderate level of deficiency (17%, level < 20 ng/mL) in both groups. Soldier participants significantly improved their vitamin D levels post-deployment with the control group achieving a “sufficient” level; M=34.9 ng/mL. Post-deployment bone turnover measured by osteocalcin was significantly higher in the telehealth group (22.0 + 0.99 vs 28.3 + 1.1 ng/mL; p = 0.01) and change in sport index was positive for this group but negative for the control group (-0.17 + .09 vs 0.29 + 0.11; p = .01). Improving vitamin D status and remaining active while deployed appears to sustain healthy bone density in young Soldiers. Bone density remained stable with no significant difference between groups. Early and aggressive educational outreach efforts can prevent chronic musculoskeletal conditions and disabling osteoporosis.

Type of Paper: Article
Fat Intake and Mental Health in Mid Aged Australian Women
Lesley MacDonald-Wicks, Lee Ting, Amanda Patterson; David Sibritt
Nutrition and Dietetics, School Health Sciences, Faculty Health and Medicine, The University of Newcastle (UoN), University Drive, Callaghan NSW 2308, Australia; E-Mail: lesley.wicks@newcastle.edu.au
Emerging evidence relates dietary intake of unsaturated fats to mental well-being. However, the relationship between dietary intake of unsaturated fats and depression or anxiety remains poorly understood. The aim of this paper was to undertake a cross-sectional analysis of the dietary intake of unsaturated fats in a mid-aged cohort of Australian women from the Australian Longitudinal Study of Women’s Health (n= 9530; 50 – 55yo in 2001) and their relationship with markers of mental well-being (CESD-10 and SF36 Mental Health subscale). The study found that for every one unit increase in oleic acid (OA), the odds of diagnosed depression declines by 1% (Odd Ratio (OR)=0.99; p=0.03). Moreover, positive associations between total omega-9 monounsaturated fatty acids (n-9 MUFAs) and OA and Short Form-36 (SF-36) Mental Health subscale scores were found. Therefore, in a nationally representative sample of Australian mid-aged women, higher OA intake was inversely associated with the risk of depression, and both higher OA and total n-9 MUFAs intakes were associated with better mental health outcomes. Further prospective observational studies and trials with regular follow-up are required to confirm the association.

Type of Paper: Review
Exploiting Food Resources: Risks and Benefits, Challenges and Opportunities of Sorghum
: Proietti I., Frazzoli C. and Mantovani A.
: Food and Veterinary Toxicology Unit, Dept. Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
: Food security challenges, including climate changes and population growth, call for attention towards currently neglected food resources, like sorghum. Sorghum (Sorghum bicolor (L.) Moench) is a drought-resistant crop important in terms of nutritional, economic and social value, especially in semi-arid environments; it is a gluten-free staple food also valuable for people with celiac disease and gluten intolerance. Sorghum weaknesses include susceptibility to mycotoxins contamination, amino acid imbalance and endogenous anti- nutrients that partly impair its nutritional potential. This paper reviews and discusses pros and cons of sorghum as food source and investigate approaches for improving its risk-benefit balance, such as landraces selection and characterization of local food processing methods.

Title: Dietary Restriction of Sodium and Fluid in Patients with Pulmonary Hypertension: An Often Underutilized Intervention
Zeiger T, Cueva Cobo G, Dillingham C, Lee A, Burger C.
Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
zeiger.tonya@mayo.edu; Cueva.giovanna@mayo.edu; Dillingham.christine@mayo.edu; lee.augustine@mayo.edu; burger.charles@mayo.edu
Abstract: Introduction. Right heart failure and fluid retention are common manifestations of pulmonary hypertension (PH). A straightforward intervention for improved control is dietary restriction of sodium and fluid; however, such a strategy may be underutilized in clinical practice.
Experimental Section. The study was approved by the Mayo Clinic Institutional Review Board. The design was retrospective review of prospectively collected data. A specific data information sheet was completed by consecutive patients seen in the PH Clinic. In addition to visit type, demographics, diagnosis, PH severity measures such as functional class, information was collected on prior and currently provided counseling for dietary restriction of sodium and fluid, as well as specific daily amounts advised. The data was reviewed for prevalence and specificity of such advice.
Results and Discussion. To be determined as data on approximately 100 patients is under review.
Sodium Restriction, Fluid Restriction, Pulmonary Hypertension

Title: Designing and developing a smartphone application for women with gestational diabetes mellitus followed-up at diabetes outpatient clinics in Norway
Lisa Garnweidner-Holme, Iñaki Garitano, Iren Borgen, Mirjam Lukasse
Oslo and Akershus University College of Applied Sciences, University Graduate Center Unik, Kjeller, Oslo. E-Mails: lisa.garnweidner-holme@hioa.no
The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. Controlling blood sugar levels, accompanied by a healthy diet and physical activity, is fundamental to the treatment of GDM. Currently, patients register their blood sugar levels in a leaflet and receive verbal or written health information at the clinics. A mobile smartphone application may provide patients tailored and easily available advice to register and control their blood sugar levels. The aim of this paper is to document the process of designing and developing a smartphone application (the Gravid+ app) to easily register blood sugar levels and to provide tailored information about healthy eating and physical activity. This formative research included expert group discussions among health professionals, software development professionals and researchers in nutrition, physical activity, obstetrics and midwifery. Individual interviews with patients were conducted to discuss different prototypes of the app. Results indicate that involving both expert groups and patients is important when designing a mobile health care device. Behaviour change techniques such as self-monitoring, perceived severity and benefits, as well as cues of action will be included before testing the app in a randomized controlled trial at the outpatient clinics.
Keywords: Gestational diabetes mellitus; mHealth; user-centered design

Title: Clinical Potential of Hyperbaric Pressure Treated Whey Protein
Larry C. Lands
McGill University
Whey protein in cow’s milk is comprised of a mixture of several globular proteins, which provide a rich source of essential and branched chain amino acids. Bovine whey protein has been demonstrated to support muscle accretion, antioxidant activity, and immune modulation; however, certain whey proteins are not readily digestible due to their tight conformational structure. Treatment of whey with hyperbaric pressure results in protein unfolding. This enhances protein digestion, and results in an altered spectrum of released peptides, and greater release of essential and branched chain amino acids. Pressurized whey, through a series of animal model and clinical studies, has been demonstrated to enhance muscle accretion, reduce inflammation, improve immunity, and decrease fatigue.

Title: Dietary Advice and Collaborative Working: Do Pharmacists and Allied Health Professionals Other Than Dietitians Have a Role?
Jane McClinchy1, Julia Williams2, Lynne Gordon2, Mindy Cairns2 and Gail Fairey3.
1 School of Life and Medical Sciences University of Hertfordshire, College Lane, Hatfield, Herts, United Kingdom AL10 9AB
2 School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, Herts, United Kingdom AL10 9AB
3 Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Herts United Kingdom HP21 8AL E-Mails: j.1.mcclinchy@herts.ac.uk
Abstract: Long term health conditions either wholly or partly diet-related continue to increase. Although health care professionals (HCPs) have a role in the management of patients with long term conditions, there is limited research exploring whether those other than dietitians have a role in the delivery of dietary advice. This research aimed to explore Pharmacists and Allied Health Professionals (AHPs) other than dietitians views regarding the provision of dietary advice to patients. The research involved a qualitative methodology utilising five uniprofessional focus groups with 23 participants. All groups considered the provision of dietary advice in the context of their own professional roles, discussed issues regarding referral to the dietitian for specialist advice and most discussed the need for written information. General conclusions are made about the value of collaborative working, the importance of communication between health professionals and access to written evidence based information to ensure patients receive timely dietary advice.
Keywords: Communication; education, patient; focus groups; health care professionals; health care, interprofessional; nutrition / malnutrition

Title: Of What Value is a 1:1 Multidisciplinary Weight Management Clinic?
Desley Turner and Nadim Haboubi
Aneurin Bevan Health Board Multi-disciplinary Weight Management Centre E-Mails: nadim.haboubi@wales.nhs.uk
Abstract: Background. Obesity management in Wales includes provision of a 1:1 Multidisciplinary Weight Management Clinic (MDWMC). Strategic management of obesity in Wales is guided by The All Wales Obesity Pathway and recommends MDWMCs for people with obesity who have one or more co-morbidities and who have tried several interventions without success, or who have complex emotional relationships with food.1 No known previous studies have included a qualitative evaluation of a MDWMC. Objectives. To conduct a service evaluation of a 1:1 Multi-disciplinary Weight Management Clinic to evaluate associated physiological benefits and qualitative data about the service. Methods. Semi-structured interviews were conducted with 180 patients attending the MDWMC at Aneurin Bevan Hospital, Ebbw Vale, Wales. Results. The MDWMC supports weight loss with 95% of patients reporting loss. For those whom baseline data was available 73% lost at least 5% of initial body weight. 88% of patients prefer individual appointments and over 90% of patients who see each team member find consultations useful. 69% of patients report improved health mainly due to a decrease in obesity-related symptoms, and of patients taking obesity-related medication 48% report a reduction in dose of medication for asthma, 42% report a reduction in dose of antidepressants and 36% report a reduction in dose for medication for diabetes. Of employed patients 30% report a reduction of days taken off work due to sickness. 96% of patients would recommend the clinic to others. Conclusions. A 1:1 Multi-disciplinary Weight Management Clinic provides value in reducing obesity and symptoms of obesity-related diseases. It also is a treatment choice favoured by patients.
Keywords: obesity; weight management; BMI

Title: Comparison of a vegan diet plan with a traditional and modified Daniel Fast on anthropometric and biochemical markers of health
Richard J. Bloomer*, Trint A. Gunnels, JohnHenry M. Schriefer
Cardiorespiratory/Metabolic Laboratory, The University of Memphis, Memphis, TN 38152, USA; Email: rbloomer@memphis.edu
Abstract :
Background: We have previously noted beneficial health outcomes when individuals follow a dietary restriction model known as a Daniel Fast (DF). This is true whether individuals eliminate all animal products or include small amounts of meat and dairy in their plan. The present study sought to compare anthropometric and biochemical measures of health in individuals following a traditional (vegan-based) or modified DF (inclusive of ad libitum meat and skim milk consumption), with those following a standard vegan diet. Methods: 35 subjects (6 men; 29 women; 33±2 yrs; range: 18-67 yrs) completed a 21-day period of modified food intake in accordance with guidelines provided by investigators. Subjects reported to the lab for their pre- (day 1) and post-intervention testing (day 22) in a 10 hr fasted state. Blood was collected for determination of complete blood count, metabolic panel, lipid panel, insulin, HOMA-IR, C-reactive protein, and oxidative stress biomarkers (malondialdehyde, advanced oxidation protein products, and nitrate/nitrite). Heart rate and blood pressure were measured and body composition was determined via dual energy x-ray absorptiometry. Subjects’ self-reported compliance, mental and physical health, and satiety in relation to the dietary modification was recorded. Results: No interaction effects were noted for our outcome measures (p>0.05). However, subjects in the traditional DF group reported an approximate 10% increase in perceived mental and physical health, with a 25% reduction in malondialdehyde and a 33% reduction in blood insulin. Systolic BP was reduced approximately 7 mmHg in subjects assigned to the traditional DF, with an approximate 5 mmHg reduction in subjects assigned to the modified DF and the vegan plan. A small (2 mmHg) reduction in diastolic BP was noted for subjects in both DF groups; a slight increase in diastolic BP was noted for subjects assigned to the vegan group. An approximate 20% reduction was noted in total and LDL cholesterol for subjects in the traditional DF group, with an approximate 10% decrease for subjects in the modified DF group. No decrease in total or LDL cholesterol was noted for subjects in the vegan group. Conclusion: These data indicate that both a traditional or modified DF may improve blood pressure and blood lipids in a clinically meaningful manner. A traditional DF also results in a significant reduction in blood insulin and oxidative stress. Although a standard vegan diet may improve systolic blood pressure, it does not appear to favorably impact other markers of health measured in the present study.
Keywords: Dietary modification, nutrient intake, lipid panel, veganism, oxidative stress

Title: The Effects of an 8-week Health Promotion Program on Nutrition and Physical Activity in a Low Socio-Economic Elementary School
Melanie Poudevigne 1,*, Cynthia Jackson Jenkins 2, Kathy Marshall 3, Chris Pitsikoulis 1, Manning J Sabatier 4, Lee Stoner 5
Affiliations: 1 Department of Health & Fitness Management, Clayton State University; 2 Unique Minds, Inc.; 3 Southern Regional Medical Center; 4 Department of Physical Therapy, School of Medicine, Emory University; 5 School of Sport & Exercise, Massey University
Abstract: BACKGROUND: Childhood obesity has risen to epidemic proportions in the United States. Children spend the majority of their day in a school setting, proving an optimal environment for targeting obesity. The current study was designed to evaluate the efficacy of a simple, school-based intervention designed to improve nutritional and physical activity behaviors of elementary school children attending low socio-economic status (SES) schools. METHODS:  Thirty-three, fifth grade students were recruited from low socioeconomic elementary schools in the southeastern US. Students were randomly assigned to a treatment or control group for 8-weeks. The intervention group received weekly dietary advice and completed a weekly exercise protocol. Physical activity and dietary assessments were completed at baseline and at the end of week 8 using the CATCH Kids Club After-School Student Questionnaire. RESULTS: In the treatment group we found increased physical activity and increased knowledge of proper nutrition. However, there was no change in BMI. CONCLUSIONS: School-based interventions can play a pivotal role in educating healthy lifestyle choices among children. Further study is required, on a larger-scale, to ascertain whether healthy lifestyle education can be used to tackle obesity among children from low SES schools.
Keywords: childhood obesity; school-based; intervention; nutrition; physical activity; health education

Title: Identifying malnutrition in an elderly ambulatory population: agreement between validated screening tools
Alison Yaxley1, Maria Crotty2 and Michelle Miller1
1 Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University
2 Rehabilitation, Aged and Extended Care, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University
Malnutrition is common in the elderly and often goes unrecognised and untreated. Effective treatment of malnutrition relies on accurate diagnosis. Australian evidence based guidelines for the management of malnutrition indicate that only the Mini Nutritional Assessment short form (MNA-sf) and Rapid Screen have been validated for use in the rehabilitation setting. However, other screening tools exist including the Simplified Nutritional Appetite Questionnaire (SNAQ) which has been validated in all other adult settings, therefore the aim of this secondary analysis was to assess the validity and reliability of two of these tools within a rehabilitation population. 225 ambulatory rehabilitation patients (48% male; mean age 71.6 years) completed the Council on Nutrition Appetite Questionnaire (CNAQ) and the SNAQ, and these screening tools were evaluated in comparison to the Mini Nutritional Assessment (MNA) as a reference technique. For identification of malnutrition the CNAQ had sensitivity 50.7%, specificity 80.7%, positive predictive value 82% and negative predictive value 49%, compared to 25.7%, 92%, 86% and 42.5%, respectively, using SNAQ. Assessment of reliability indicated significant slight agreements between MNA with CNAQ (κ = .278, p<0.001) and SNAQ (κ = .149, p=0.001). Results indicate that neither the CNAQ nor the SNAQ have a high level of validity or reliability in this frail elderly population. The authors recommend the use of MNA-SF and Rapid Screen in the rehabilitation setting as recommended by the Australian evidence based guidelines in preference to either of the screening tools evaluated in this study.
Malnutrition, Older adult, Screening, Rehabilitation

Title: Becoming Food Aware in Hospital: A narrative review of best practices for a multi-level approach to improve the culture of nutrition in hospitals
Celia Laur1, James McCullough1, Dr. Heather Keller1,2
1University of Waterloo, Waterloo, Ontario, Canada 2Schlegel-University of Waterloo, Research Institute for Aging
The Nutrition Care in Canadian Hospitals (2010-13) study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%, with older patients more likely to be malnourished. Nutrition practices in these hospitals, including diagnosis, treatment and monitoring of malnourished patients were ad hoc. This lack of a systematic approach has demonstrated the need for knowledge translation of best practice. A multi-level approach is proposed to address this complex issue. Care practices discussed are based on grey literature and evidence to date, which encompasses training and methods of action for hospital staff including hospital management. Patients and their families also need to be included in this multi-level approach as being aware of the importance of nutrition can make a patient more involved in their recovery. This approach encompasses but goes beyond the UK Age Concern Seven Steps to End Malnutrition and the Australian Eight-Step Interdisciplinary Framework on the Prevention of Undernutrition. Improvements to organizational practices include use of screening tools, protected mealtimes and additional nursing or nutritional assistants during mealtimes. Everyone in the hospital should be aware of the importance of nutrition and their role in the optimization of nutrition care. Overall, this proposed multi-level approach aims to improve the culture of nutrition in hospitals.
malnutrition; best practice; hospital; older adults; education; training;
Funder: Technology Evaluation in the Elderly Network (TVN) Catalyst Grant Program

Title: Vitamin D as an immunomodulator: risks with deficiencies and benefits of supplementation
Goldsmith, Rachel B1; Goldsmith, Jason R2
1 MPI Research, Inc., Mattawan, MI, USA; 2 Department of Medicine, University of Michigan, Ann Arbor MI, USA
Abstract: Vitamin D refers to a class of fat-soluble secosteroids often associated with their role in absorption and metabolism of minerals such as calcium and phosphate.  In recent years, our understanding of Vitamin D has expanded to include its role in modulating the immune system.  Of particular focus are the effects of Vitamin D deficiency and supplementation on patients suffering from disorders due to dysregulation of the immune system.  In patients with multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease, deficiencies in Vitamin D have been associated with an increased risk of disease activity.  In this review, we will look at the current state of research in regards to the relationship between Vitamin D and immune-dysregulation.  We will focus on both the risks associated with Vitamin D deficiency as well as the benefits of Vitamin D supplementation.
Keywords: Calcitriol; vitamin D; cholecalciferol; ergocalciferol; immunomodulator; inflammatory bowel disease; multiple sclerosis; rheumatoid arthritis

Last update: 19 January 2015

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