Correlation Between the Vitamin D Intake with Clinical Symptoms18052017151908

s

ATTANTIS PRESS

Atlt,rtnces in Heoltlt Sctences Research' t'olunte I

lst Public Health Intemational Cont'erence (PI-llCo 20 l6)

Netti Suhartir, Teda Faadhilar' Delmi Sulastrir t _{ltl i c r o b} i o I og,- De p a rt nrc nl, A nda I as LJ n ive rs i tv' I ndo ttc s i tr

ne l t i

-su hlr li@Yahoo co id

) _lvl

e cl i c ct I F ac tr I t1', .4 nd al as l-i n iv e rs i tv, I nd o nes i a

tedaf aadhr Ia GYahoo' com

3 _{Ntrlriliott Deporlntenl. Andalos} LJniversitv' lndonasict

delmi sulastriGYahoo' com

correlation

Between

the

vitamin

D

Intake

with

Clinical

Symptoms

of

Patients

Pulmonary

Tuberculosis

Abstrlct- \ritanrin l) is knou n to enhancc the intntune rcsponse

io nrrl.orrr.t.tia. Approxinratell one million pcople sorltllide ,r,.c cstinratett to hai,c ritirnrin D tleficicncl' or insufficiencl.

i:firl.rf s)'nlptonrs of pulntonarl' TB patients all'ectcd b1' thc inrrilune resl)onsc to nr1'cobitcteria :rntl _- :lrc not directll'

i,riir."..a b1: r'itamin D. -l'ire ainr of this stud) u'as to deternrine

il e correlation behr ecn vitrrnrin D intake u ith clinic:tl s) rnptonls

of patients uitlt pulntonitt'l tuberculosis' l'he. nrcthod of this

,,,,irl ,rr,. cross sectionitl stutll to 52 patients pulnrontrrv

irt .i.utn.ir. Thel' u ere interr ioicd l ith :t questionnaire l''FQ'

i:ir.

^,rrornt of iitanrin D intatie

$as cnlcula(e(l b1' using the

softlarenutrisurrcr'.(llinicalsYnlptonlsof.-l'Bplrtients

,r.r.,.tr..4 b1' using Baridinr -l llscorc"fhe1' rre dividcd into three

..i.g.,,'1.,, igS.ut. gratle I (mild), TllScorc grade Il (nrodcrate)

,"iiU Score gradc lll (severc)' Statistical an:tllsis of the nro

.l..infrf.. ucre allegetlll linked using Sl'SS solflalc' ln this

;;;i ;1l. average iniake of Iitantin D respondents is 5'8(r * 5'15 ,rr.g. fniri nunih.r. is rerl'sntlll contparcd lith.the rninintunt

i.rit of,ti.t,r.1 \itnn)in reconrnrcnded lbr Intlonesian pcr person ncr tlitt' {15 rncg). 1n tlris stutll thc rcspondents uho have liris.,,,:- _{gra,lc I ir,rr 92.J'Zr, the} respondents u ho havc '[BScorc

,rrrle II rvrs 7.(r9'2, and nrlne of the respontlents \\lro lrnve

ij;J;";; g,',,r'r. rrr. l'he avcrgage of 'r[]Score is 2'0'l + l'89'

Ilirsed on ihe statistical anall.sii, p r.rrlue is 0.2{J (p> 0.05).1'hus,

it can be conclutled that tlrere \rAs tlo significtnt association

ir.nri..n thc intake of vitanrin D lith clinical s1'nrptoms of

pulntottarr' 'l'13 prrticnts in the I'adang citl '

Ke.t ttorls_ Tube rculosis, \'itarni n [), I nt nt une s] stc m''l' I]Scol's' \ ut rition

I. INTRODUCTION

TttbercLrlosis

(TB) is

one

of

the

rtra.ior plrblic

healtlr problerrls toclay arrd irrclttded in. the global

enrerge;cy. TB is the leading caLISe of death due to

secor; iniectiorr after

HIV

in rvorldrvide' By 2013

it is estirlated at abotrt 9 million people suffer tiorll TB ancl 1,5 rnillion people died

frorl

TB rvorldrvide' 360.000 of tvltorn are HIV-positive

Il]'

More tltan half

ol'TB

patients in the world (56%)

are

in

Southeast

Asia

and

the

Western Pacific region. Most cases are

ill

Africa, a quarter

of

all

.ui.,

rvith

arl

itrcidence

of

280

per

100'000 population. The six cotrntries rvith the highest TB

ln.i,t.n..

in

2013 r'vere India

(2'0 -2'3

million)'

China

(0.9-l.l

rrrillion), Nigeria (340'000-880000)' Pakistan (370.000-650.000), Indonesia

(410'000-520.000) atrd Soutlt Africa (410'000-520'000)

[l]'

The prevalettce of

TB

irt Itrdonesia is 0'4% rvith

the lrigirest prevalettce fouttd in West Java (0'7%)'

RapLri 10,6;/01, Jakarta (0,6%), Gorontalo (0,5%)'

Banten (0,4y0)

atrd West

Papua

(0,4%)'

West Suntatra ltas

a

prevalence 0,2%

[2]'

Based

otl

the

anuual report of the Padang City Health Departnlent

in

201

3,

foLrnd positive pttltnonary tubelcttlosis

patients

925

( I I

'56%)

of

8'005

suspected

pulmonary trtbercttlosis. When compared with the

past ferv years, cases of pultnonary TB continLres to

iise.

ln

2012

tlre

rlLrlrber

of

positive ptrlmonary tuberculosis patiellts as

lllally

as 603' as

lrally

as

680 cases in 201 1.2010 as rrany as 853 cases' 2009 rvere 7,18 cases atld in 2008 as lllally as 699 cases

t3l.

'

The percentage

of

patients r'vitlt pulrnonary TB"

Acid

Fast

Bacilli

(AFB)

+

r'vlto recovered after

collpletioll of the treatnletlt period is called the cttre

rate. The cllre rate

of

West Sltlnatra

in

2004 and

2005 is altltost close to the ttatiotral target

of

85% t4l

There

are

several factors

that

influence the

sllccess

of

TB

treatlrellt

including gender' age'

Coplright'-tl 2017' the ALrthors Published b1'Atlantis Press' -l-his

is an opcn acccss article trrlder the CCI BY-NC license (http://creatirecontrnotrs org/licenses/b1'-nc/4.0/)'

I

ATTANTIS PRESS

,1clt,onccs in Hccrtth.Sctettccs Rescorch t'oItutte I

diabetes

mellitlls'

HIV,

pregnallcy, lllalllutrition' smoking, cofiicosteroid therapy, genetic factors'

t.r,rirui'

kidney disease, social

or

environmental and compliance [5].

Approximately one

rlillion

people rvorldr'vide are

estimated

to

ltave

vitatrin

D

deficierlcy

or

insufficiency" defined insufficiency rvas levels ol'25

(OH)

D

= i0

ttg

i

nrL

[6].

lndonesia

is

also

experiencing

the

salne

thing'

Researclt

in

48 districts in indonesia' which irtclttdes 300 children aged 2-12 years shorved

tltat

Ittdonesiart cltildren .6,,rr,,.,,.

thi

food sotrrce of calcitrrn and vitamin D

were

lorver

tltatt

the

recotntrletlded tttttrierrt adequacy [7].

vitunll'i

D

is rrsed in the treatrnettt of

TB

in the

preantibiotik era. Cod liver

oit

is often used to treat

patients

rvith

rickets and

TB' In

the

mid

l9th

century,

Willianrs

reported

that

there

is

irnprovernent

in

patiellts

with

pulntottary

tuberculosis

after

cotlsutning

large

anlotlnts

of

vitamitt

D:.

Then begin vitarnirr

D;

isolated frotn cod liver oil to treat tuberctrlosis tllere irt 1930 and

is

rridely used

to

treat attd prevent

TB

trntil the

discovery of antibiotics in 1950 [8]' Vitanrin D may

improve

the inltlttne

respollse

to

ruycobacteria'

Viiamin

D

deficiency is cotnmon

in

patiettts rvith active TB [9].

Clinicat sylnptolrls

of TB

patierlts

is

influerlced

by

a

host

tf

factors, nlicrobial factors and the

iriteraction rvith the microbial host' Host of factors including the age, itrlt.uutre status. comorbidities and

BCG

irimunization.

Microbial

virulence factors'

arrong others. and

a

predilection

tbr a

particular netrvork.

As

rvell,

the

interactiort

of

host

attd

microbes that includes the body pafi irtvolved and the severity ofthe disease _[10]'

Researcir cortducted by Martineau et al in Lottdon

on 192 healthy adults r'vho had a history of cotttact

rvith an active

TB

patients sltorved att iltcrease itr

ir:rmunity

of

tny'cobacterirttl tubercttlosis

in

tlte group

gir.,t

2,5 mg

of

vitattlitt

D

for

6

rveeks' Measttretleuts \vere

rlade rvith

BCG

lux

assay-nretltocl. Shorved that the grotrp receiving vitamin D has a BCG tneatt 24-ltottr lux assay ltttttittellcellce

ratio is 20oZ louer thatt tlre group rvlto received a placebo, in other words, vitarnitt D can reduce tlte

viability

of the

bacteria

Mycobacteriunr Tuberculosis

Il l].

The airn

ol' this

study rvas

to

detertnine tlte

correlatiott betrveett vitatnill

D

intake with clinical

syrrptoms of patients with ptrlrnortary tuberculosis'

II. METI_IODS

The

ntethod

of

this

study rvas cross sectional study

to

52 patients pttltnonary tuberctrlosis' Tlrey

,u.r.

int.ruierved

rvith

a

qttestionnaire FFQ' The rnean

of

vitamitl

D

intake was calcttlated by usirtg

the sotlrvare ttutrisurvey. Clinical symptonls of TB

patients Itreasltred by trsing Bandirn TBScore' They

are divided into tllree categories: TBScore grade I

(nrild). TBScore grade

tl

(rnoderate) and TB Score

grade

lll

(severe). Statistical analysis

of

the trvo

variables using T test with SPSS software'

1il. RESItLTS

The resttlts can be ktrorvtr by tlre presentatioll

of

the follorving.

TABLE I

THE FREQUENCY DISTRIBUTION OF THE LEVEL

OF CLINICAL SYMPTOMS

't _{rI f}

Level I .18 92.3

Level I I + 7.69

'l'ot:rl <) I00

Table

I

knorvn that lnost respottdents have a level I TB Score is 49 _PeoPle

(92j%)'

TABLE II

THE AVERAGE OF TB SCORE AND VITAMIN D INTAKE Yariable \+s l) \l in-\l:rr

'l'li _Scorc 2.04r I .89 o-7

Vilanrin D

l!q!C-

5.8615.45 0. l -24.4 Table 2 that the average

TB

Score respottdettt is

2.04

+

1.89 mcg.

The average vitalnin D

irrtake respottdertt 5.86

t

5,45 rncg. This antount is very

lorv

if

colnpared

to

the tnittitntttn level

of

dietary

vitamin

recotnttretrded

for

people Irtdottesia per

person per day by the Minister

of

Health Republic

of lndonesia Regulation 2013 is

l5

urcg'

TABLE III

CORRELATION BETWEEN VITAMIN D INTAKE

WITH CLINICAL SYMPTOMS OF PATIENTS

PULMONARY TUBERCLJLOSIS

[image:2.612.338.516.307.377.2]

e

ATTANTIS PRESS

Yaliable (.li nical SvpnrtonlPs

\+SD P vlluc

Vitarnin D

I ntake

TB Soore I 6. I 2+5.54 0.243 TB Score ll 2.78t3.i6

.4dvances rn Health Sciences Reseorclt' volunte I

Table

3

kttowtt

tltere

is llo

difference

significant between vitamin D irrtake pulmonary TB

pa-tients

with clinical

symptoms

level

iight rvith

pulmonary

TB

patients

lvitlr

clinical

syrnptonls of

lnoderate

becattse p = 0.243 (P value> 0.05)'

only necessary

if

insufficient exposure

to

the sutt

It+1.

nfter

expostrre

to UVB

rays (UVB: 290-315

nnrj,

UVg

photon beatn causes photolysis

of

7

J.fii,fro.flotesterol into pravitamin D3, pravitamin

D3

then

undergoes

tlternral

isomerization

at

a

temperatlrre of 37 o C to vitarnirl D [15]'

Deternlinarrt

of

vitarnitt

D

status consists of:

exposure to UVB radiation, clotlrirtg, nutrition' BM[' ,"ru,',., cholesterol, artd gelletic factors

like

skin pigmentatiolt and ellzyllles

in

the

n-r.etabolisrn

of

viiamin

D

tl6l.

Exposttre

to UV

radiation

is

the

lV.

DISCLISSION

nlost detenrinant factor

Il

7].

Statistical test results in this study rvas obtained

p

Serurr levels of vitarnirt D increase progressively value = 0.243 (p> O.o!1, then those results shorvecl

in

line

rvith

increased expostlre

to

UV

rays'

ruo associatiott

u.trr..,,

vitatnin

D

intake

rvith

Researclt conducted

by

Shalliker

in

2013

to

208

clinical

symptoms

oi

puln.,onory

TB

patients

healthy people slrorved that. Questior.rnaires rvere because there is

"o 'ig"ihtont

difierence betrveett

adrninistered

cottsisted

of

demographic

the amount

of

vitamiriD

intake

of

pulmoltary

TB

cltaracteristics' diet' alcohol' anrotltlt

of

tilre

spettt patients

clinical

symptonls

of

nlild

to

nroclerate outdoors during 09:00

to

l7:00 pnr

for

l6

rveeks'

clinicalsymptollls'Researchet.sStlspectthisisuseof,.,.,",,.,..]-,atldsetlsitivity.Weekl6allbloocl

because the ratio

of

tlre Irrtttlber

of

samples in

the-

sanlples

\\'ere

collected

alld the

restllts

are

grotrpofnrildclinicalsyrnptonrsrvith.a.grorrpofcttrvilinearrelationslripbetr,veenSertlltllevelsol

clirtical syr.nptonls

'uere

'rot

balanced

48:

4'

ln

vitatnitt

D

rvith

exposure

to

UV

rays; sertrtll 25

adclition, both groups had the sarlle average

intake

(OH)

D

increases rvitlt increasing exposure 10 UV

of

vitanlin

D

belorv tlte recottltnended so that

no

ioy'.'p

to 89 nmol

/

L and thett decreased at higher visible difference irt irttake significant' Horvever'

if

exposLrre [18]'

vierved average intake

of

vilamin

D

betrveert

tlte

itood

inta(e

is

ustlally cottsidered sufficiertt

to

twogroups.intakeofvitanriltDirrthegrorrpofrepresel]tvitanritlDstatttsifexposttretosLrnliglrtis

nrildclinicalsylllptolllsishighertltantlreairountofignored[19].IrtasttrdycorldttctedbyLuntsderlirt

vitantirt D in the grotrp of clirtical symptollls

\Yel'e' iool

sho'vi tlrat tltere

is a

rveak relationship

Based on research cottclrtcted Nursyant year

2006'

benveen dietary intake attd sertlrrl 25

(oH)

D in the tltere are no difterences in tlte levels of

hemoglobin

TB

groLrp' lnstead' tlte assesstttettt

of

exposLlre to

and

BMI

wel.e

.ignln.o,1t

betweeu

the

grotrp

onty-UV'tight is not enotrglr to describe tlte stattts

of

receiv illg Anti TB D;;;g;

inrsl

and V itarn irr D

and

v itani in o

izo].

Mc Car1y. irr 2008 tried to

calcttlate

the groLrp receiving

nfg

uno placebo.

Hemoglobin

the status

of

vitarnin

D

through sUnlight exposLlre

and BMI is a conrpouent in deierrnining the lelvel

of

questionuaire. Horvever. the calcttlation of vitanritt

clirricat

syrnptonls

of

pulrronary

TB

patients.

i

status through questiottttaires sttttligltt exposttre is Horvever. there are significarlt differerrces itt

ternts

less representative becattse

a

low correlation

rvith

ol

the

cotrversiott

;f

sptrttllll

and

radiological

sertlrll levels of vitamilt D [21]'

picture antoug the

groupliu.n

vitanrin D rvith

the

Researchers have

yet

to

tlnd the

factors that group giveu placebo.

il]l,

prou..

that vitarnin

D

influeuce

it.

Absence

of

relationship benveett

cloes affect the cellular inrnrune systern

[12]'

vitamirt

D

irltake

rvith

clinical

symptonls

of

Desai

in zorz

reforied that

te

puiitnit

Itewly

pttlmottary

TB

patients in

.the

Padang

city

is

diagrrosed'nvith

vitamin

D

cleficiency

due

to

infltrenced

by

several

things' Tltese

factot's inadequatefoodintakeandlackofpatientexpostlreassociatedwiththeitrttrttttleSystelll'Tlreitlrltltttre to strnlight. Vitanrin

D

is a conrpottnd that can

besysteln

is a cornplex arlcl intlLrenced by nlarly things'

s)'nthesized in the skin arlcl

it

is ihe main source

of

ln

tltis sttrdy' samples

ol

l 8-60 years

old'

At

this

vitattlin D tbr nrany people

[13]'

Source

of

food

is

age

the

ittinlu're

systenl

that are

irt

tlte

best

ATLANTIS PRESS

..ldvcrnces in Health Stierrccs Research' volunte I

trl

The results

of

this study can be cottcluded that there rvas

no

significant association between the intake

of

vitamin

D

rvith

clinical

symptortts

of

pulmonary TB patients in the Padang City'

REFERENCES

Ir1\ul..lol)ol4)tllobalTuberculossisRepon'IOnline]Available:

tri "t""

rn'- -rr-' hrtstrclnr.l()66--l'7(t9'lil-97891'll-(r'18(l9cn"

odf

ffisrc Healrh Research Repubtic Of Indonesia' furttc Hurlrh llcsaurch ilii,,,-,t tir',,i tn,i,,rc"rttt 20i3. .lakana' Minrsrry ot'Health RepLrtrlic ol' lndonesra, l0 I l

il;;i;";;;'i;,r.nt ol Padans Citt' t'trkrns ( tt) Hcutttl t'nlitc in

2///2. Padang Cit) _' Health Departement' 20 I 3'

i'ii.. ia,"r,i=ir.,r; LM. l'(ttt';li\tdogr: Krntt'Jt Klrttt't I'ntsas-l'rxct l'aryr*tr, Jakana. ECC, l00l

frlniti.ri' L. Prtvanri ZS, Tlrndra YA' Fallor-lhklor \ang iti.*p."*.",t,i Keiernbuhan Pendertta TB Poru" i /(('vui _'ri"" \ol 7' 1007

U"f i.f.Vf . "Vitamin D Deticiencl'," )t' lingt 'ltncd' vol 357' pp 266-81.2007

V.f

""u,,. V. Palupi NS' Andarrvulan N"'Asupan

Kalsiurn dan

Vii.,r,i,l O patla anak lndonesia Usia l-ll TahLrn" '/ lckruil dtttt lnluttrt fung(ttl' vol l5' lan l0l4

n.,it, Hl. lintt I'cny*tt /1rrrr, Surabaya' Deparlemen Ihnu Penl-akit Paru FK Unair RSUD Dr Soetorno' l0l0'

f.i.nin..r, AR, Old Wine ln Nerv Bottles Vitarnrn D. in the

i;;;;;;;t'"nJ P,evention o[ Tuberculosis"' in /'rrrc Nutririon Societl 2011. poPer 7l 8'l-8q.

or,"iii.l Lot".rc Societl. "Diagnostic Srandards and. Classilrcation "i'irt*r."i"-.i, in Adulrs and children."

Am .l ltc.sprr ('nr ('trrc \1cd..

vol. l6l : Ii76-1395. 2000'

frlrnit*, AR, Wilkinson R'|, Wilkinson KA' Ne$1on SM' Katrpnrann g, _{H;iiBM, ti,,i} "A Single Dose olViramin D Enhances-lrrmunitv to

illi."t..i.ii^. .4i,,p,1 17s,-p,, ( rtt ('(trc Ay'crl' vol t76 : 208-1195' 2ll' conditiorls. In olcl age, already thele is a decrease ln

ttr.

froOu.tion

of

B

cells and

T

cells in tlte bone marrorv and thymus,

alld

decreased function

of

,nor,,t. lymphorytes

ilt

secondary lyrnphoid tissues

122).

'

in

_{infunt, ancJ chilclrelr tlte immutle systelr is llot}

yei fulli,

developed. L1'nrphoid organs gradually

oOa

,.rui,

durittg lllattlratioll and do rlot reaclt full

\\'eight into adtrlthood' The average nunlber peyer

frut! is

half the

Irurlrber rnature

at

birth

arld

lruJuoflv

ittcreased

tlntil

the

average rltrnlber

of

i',J,,lts eic.eded the aged teens [23]' Meanrvhile' at

;l;

;r,-rg

age

of

the productiort and firnction ol'

i,.rrr.,r',n.

Ielli

are

still

going \Yell' B cells prodrrce antiboclies that attach

to

cells and helps destroy

;;;l.g;,,t.

Tlre set T cottsists of, hetper T cells and

Iitt.ti

cells. Helper T cells help B cells to prodtlce

aLrtibodies

and also

increases

the

ability

of

am-ls

of

the

itltltttle

systelll,

decreasing the

frotiferatio,r of

T

lymphocytes and.lynrphoid tissue

atroptly. Koethe research

itt 20ll

shows HIV

;;;;il

with

lor'ver

BMI

and rvith the increase itr

'gNaf

of

less

than

l0%

dr"rring

the

follorv-ttp

significantly

redrlces

the

recovery

of

CD4

+ lyinphocytes.

ln

this

study,

CD4

+.lymphocyte

recovery

seell

greater

irt the

group

oioverireight [27]. Currently ktrowtr terttt "obesity purrdo*" ttlt,i.ti is estimated obesity associated $'ith

'i,rproued prognosis itt patients \Yith

-ciltical illrless'

bui the explanation of this is unclear [28]'

V. C]ONC]LLJSSION

rnacrophages to fight pathogens [24]'

Another-

tactor

is

the

uracrotrtttriellt irrtake' Macronutriellt collsistillg of carbohydrates' fats and

proteins. In the itntlttlle systelll, Il-lacrotrtttrient lllost

piuyt

it

protein' Proteitt

irr

patietrts reqtrired to

..iuUfitf"r

a

cvtokine

that

is

used

in

the

body's

0.i.,*.

systenr.

Tlte

atnouttt

of

cytokirtes

itt

tlte body'

rvill

affect

the

patient's inrnlttne system' Cytokines

are

proteins

that

regulate irtteractiotts betr,'een cells arid play a role itt the activatioll of T

cells. B cells.

lllollocytes.

lracrophages'

inflainnration attd indttction of cytotoxicity [25]' ln

research that has similarities corldLlcted

by

Sari in 2015 of the same sanrple obtained an average irltake

of

prot.in salllples according

to

tlte recolnlllellded

arroLil.lt.

that

is

equal

to

78,477 granls

i

day'

If

,i.r"ed

irt terttts of ihe protein stlpply' the santple is expected to have an adequate

itltltttre

system pafily because ofthis factor.

-

noOy Mass

lndex

is

also kuorvtr

to

affect the

i,.,rmune systerr.

ln

this

stttdy, 38 (73%) patients had a noriral

BMI

(>

l8)'

Research conducted by

Ilavska

in

2012 indicates

that

tltere

is

a

strotlg r.elationshipbetrr,eetlBMllviththeltttnrattit-l-tt-ttttne

syster.rl.

Tilis is

especiall)' mo.re prollotlllced in

wolnell. Paratrletet's that he took as

a

llleasllre

of

in-ttnune systelr enhallcelllellt' alrollg others' CD3'

CD4. CDb,

CDI6

+

56.

CDI9"

HLADR.

CDIIb'

CDllc,

ancl CD54

[26]'

Moreover' trrldernLrtritiorr

associated

rvith

strppression

of

antigelt-specific t31

t{l

t5l

t6l t7l

t8l tel

t t0l

tltl

tlll

I l]l

I l1] I l5]

2007

irrrru,n, EW, Arnin Z, Rutnencle CM' "The el'f'ect oi vitatnin D as

suoolernenllrv trelllnenl ln pallenls *ith ntoderatelv advrnccd

pri,",".,. 'irfr..aulous lesion"" Actil \ltLl ln'htn''';'lnhttcs I lnr'rn ,1/.r/.. r'ol l8..lan. l()06

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il;;., ,;',,i. "ElGcts ol sunlight and diet

-on vitarnin D stltus ol

prl'r"..tl' irH."ulosis patienti in Tbilisi' Georgia ' A)rrtrrrrrr' vol' 28: 162-166,2011

;;J;;A.'tr4ates PR' Mikronutrien : Vitarnin & Mrne-ral Dalant Sirf,'ri. Uorp., Jakana, Penerbit Buku Kedokteran ECC' l0t)6 N;;l';;h;;;n: H"lick MF "Vitanrin D starus and sun exposure in snuif,...,,riia." /.rrrl", Btr*ttcncc' vol' 5 : l'l-17' l0l3'

e

ATTANTIS PRESS

.ldt,trttccs in Hcalth SL'leircc'r Resecrrch' t'olunte l

fl6lRalohAP.WlratnortC,PontororrngC.l.ctrll'''Arginineandvilanlin

l'\'l

ir"5olirr.i,-.'in.t.pi"t'n puhnoirn lubercul()sis' a rnndorntseJ' double trlind, placebo-controlied trrrl' l'l'r l5 r )'\ /: vol l8' 201 l

I l7l fUorr,r, ff ,q 'Vttatntn D: A hortnone lor all seasons ' hou muc t l' l

a.ar*'rl l'r'ld.",",Jin-*'L" ng1.' prgssures"' ('l tn lltt )L ltcn /lcr' r'ol' l5

1001

tfSt ihaflilet VN. Clements M, Fenech N4' Arnrslrong.BK Personal sun

erposure and serum 25-h1'drory vitarnin d concentrations"' -t'-li,,t,,rhtaut,.rttt'r,,ttl

l'htttohroltigt''"ot Sq'^208-:.t'l'It:

tt9l WersgC. Oleien R, Rabna P,'ftaestel P' Gustal\on P' Aabl'P' cr rrl

t ,r

':tllr,,, ,l-iiar",i't _{'t" 'in} D rn a \\'esl atiicarr population of ,uLr.r.,iroii. patienti and unmatched healthl' corttrols''' Am I Clin Nulr'

rul 86 tl?n-81.1007

t1l)]l,.nl.d.nAS.LarjthornC.Sri'aminathanR.MilbLrnrH.|.'Rei]Ctlvatlon

r-\'r :;

'il;;;i;i';,i,,,J '"t''in D detlcienc\': The contribution

oldiet and ;-p;:;;i" sunIight"' 'l hortr'r'vol 6l: I001'I007' 1007

lr I I Niia;,i Ce 's*t,gt'r c\posure assessrtrenl' citn rrc nccurltch

fls:ess

\rlarnin D e\posure trorn sunligltt (luesllonllalres) ' '1tn I ( lrtt.\ttr'

vol. 87: 1097S-l0lS. 2008'

Illl i'",irg,,., e V. t'l.o' BB. Dorshkind K' Causes' conseqtrences' and

rerersal ol-lnlnlune s\stelll aging" / ( ltn lnt'crl' vol l2l: 958-96i' l0l l

t111 Brrckler'- RH. "Prtrnarl itltnrunodet'icrencr disease due to del'ects in t-- _'

rt

',,orl,i.t,"..t' \ tinyl 'l nt'l \ol 3Jl

I I I l- I il{ 100(l

fl.l] Jlplirrese S(tclel\ l'or ltntttuttoltrSr' l.rttrt .'tnt'r:rttt t,tt,lttttttL \t.\tttn '-' -t,i,,n,prun _{l:ctltitrtltt rl lnntrn"l"tt"tl} \rtctc'ttt' (1.'l:lS) lapan"

.lapanese Societv tbr ltnnrrrnolotr ' f00r)

IlSl Brltour.llltlrt KC Rcngglnrs l"ltutttt"l"yr _'/'r'rrl r'lr''r (!-/// lalnrl'l' ' I-- r

[,,i",, p.r.tr',ii,kulrii KtJukrtr"n u.r\erstlls 1"'1t1'1g'1" ]trl l'

Il6l lhrska S. Horvathora M. Szabovir M' Nemessanl i T"lahnova E'

t- r

i,'rnil'. .r. !1 ,//. Associatlon belrveen the llunlall llnlnulle response

; ;b;Jy nrass index'" Httm lmnttrttrtl vol 73: 480-4t15-' l()ll

1:21 i,,eifre in, .lenkins CA, Shepherd BE Stinrtctte.SE' Sterling TR' "An oplinlal bod) tnass tnder ringc rssocrilled trtth trtlproved inrtnune

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;h;;il). (lrnttttl lnlitrt'tttr /)trsri'rgs' vol 53: 952'960' l0l I

f:Sf 2.,,;;i FC. Jacob V. Barbeiro HV' Silva FP' Souza HP"'lnlluence ol bodv mass tnder on tnllamnlatory protile at adrnission in cnticalll iii i"p," p.,i.rtr." !nrcntttrrtnttl 'Itttrntl ol In/luntmtttton' )0lr5'