Oral manifestations of Celiac Disease: Dentists be Aware!

Clinical suspicion of celiac disease

By Christopher Friesen

celiac disease dental enamel defects

According to a study1 published in 1989, people with celiac disease (CD) have a higher risk of developing oral cancer if they are not on a gluten-free diet. If dental professionals know more about celiac disease, and how this illness affects the entire person, including the mouth, they can help in its early detection, and possibly help their patients avoid years of suffering.

When Connecticut-based dentist Dr. Ted Malahias’s wife and daughter were diagnosed with celiac disease, their pediatric gastroenterologist asked to see his daughter’s teeth. Dr. Malahias knew diseases of the digestive system could manifest with symptoms in the mouth, but a link between CD and problems with teeth was new to him. Wanting to know more, he looked for research that might explain the connection.

It wasn’t easy to find. The North American medical establishment is not as knowledgeable about CD as other medical establishments in the world. There were several European studies that had linked dental enamel defects to celiac disease — that’s how his daughter’s doctor had known to check her teeth. CD is much better understood in Europe and other parts of the world than in the U.S.

“They’re more aware of celiac disease because the connection between CD and the mouth was in the literature from 1990,” Dr. Malahias said in a phone interview. “They are trained, especially in Italy, and they are more attuned to it than we are here.”

As he researched this connection more, Dr. Malahias contacted Peter Green, M.D., a researcher at Columbia University’s Celiac Disease Center.

“When I called him, he already knew there was a connection between celiac disease and dental enamel, but there were no papers here and he wanted to do a paper for the U.S. literature,” he said.

During that phone call, Dr. Green recruited Dr. Malahias to perform the study with the goal of linking the occurrence of dental enamel defects to CD. Dr. Malahias is a practicing dentist, not a clinical researcher or an academic, but Dr. Green needed help with conducting the study, and Malahias agreed.

“It was more of a give-back,” Dr. Malahias explained. “He said ‘do you want to do this study?’ and I said, ‘yes’ because there’s a need for it. The goal was to get that one statement out that there’s a connection between dental enamel defects and celiac disease, and that doctors need to look for it.”

To develop that conclusion, Dr. Green put Dr. Malahias in touch with celiac disease support groups. Dr. Malahias attended group functions and recruited patients and control subjects. He conducted an examination of all subjects’ mouths and documented their history of aphthae. He photographed their teeth and graded the amount of enamel defects. As part of the study, Dr. Malahias asked a second dentist to examine the photographs to check his conclusions.

Dr. Malahias then passed his research along to Dr. Green, who had statisticians crunch the numbers. Other members of the research team wrote the final paper, which was published in the Journal of Gastroenterology in 2009.2

After examining the evidence, the study revealed two main findings:

1. CD is highly associated with dental enamel defects in childhood.
2. There is an association between CD and aphthous ulcers.

The dental enamel defects appeared in childhood, the authors theorized, due to the onset of CD during enamel formation. The adults in the study did not show this same association. This may seem unusual, until the manifestation of CD is fully understood. Unfortunately, Dr. Malahias admits, his colleagues don’t yet know enough about CD.

“I think they are more aware of it, but I think more has to be done to get the word out so they know the details,” he said.

So what do dentists and other dental professionals need to know about celiac disease? According to Dr. Malahias, “Everything. They really don’t know the details. They need to understand that it’s not just an allergy, and they have to understand that the people are really ill.”

What is celiac disease?

Many breakthroughs in CD research have happened during the last 20 years, but the condition is an ancient one, well documented back to the first century A.D. Aretaeus of Cappadocia, a Greek physician, described the condition and named it Koiliakos after the Greek word for abdomen, “koilia.” Aretaeus understood that properly digested food was assimilated into the body somewhere in the stomach organs, and something prevented that process among his affected patients.

Eighteen hundred years later, several physicians treating children with the illness would lay the foundation for a modern understanding of the disease and its treatment.

Samuel Jones Gee, Christian Archibald Herter, and Willem Karel Dicke were some of the early pioneers in the field. At one time the condition was known as Gee-Herter disease in acknowledgement of the first two. Willem Karel Dicke is credited with pioneering the gluten-free diet as the treatment for the condition in the late 1930s and early 1940s.

Today, researchers such as Columbia’s Dr. Peter Green and Dr. Alessio Fasano of the Center for Celiac Research at Mass General Hospital for Children in Boston (formerly at the University of Maryland School of Medicine) are leading the research effort. Dr. Fasano is widely regarded as an expert in the field. In 2003, his research team published the results of a landmark study3 that showed that one in 133 North Americans is affected by CD.

Dr. Fasano’s study defines CD in clinical terms: “Celiac disease is an immune-mediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten.”

As Dr. Malahias said, it’s not an allergy. Rather, it is an autoimmune disorder that causes villous atrophy in the small intestine when ingested gluten produces an immune response that doesn’t attack the gluten, but instead attacks the intestine.

“The gluten is deamidated by tissue transglutaminase, which allows interaction with HLA-DQ2 or HLA-DQ8 on the surface of antigen-presenting cells,” Dr. Malahias said. “Gliadin is presented to gliadin-reactive CD4+T cells through a T receptor, resulting in production of cytokines that cause tissue damage.”

In a healthy intestine, food is broken down by the villi. Beneath them, enterocytes work on absorbing nutrients and passing them into the bloodstream. If the body encounters a particle that requires an immune response, the enterocytes pass the immune system’s cells into the intestine. Normally the enterocytes are packed tightly against one another and should remain that way.

Ingested gluten is naturally difficult to digest and, in genetically susceptible individuals, it is treated as a foreign body. The enterocytes release a chemical that loosens those tight molecular junctions between themselves, creating what Dr. Fasano refers to as a “leaky gut.” Once the junctions are loosened, gluten particles can penetrate through to the layer of immune cells under the enterocytes, which triggers the autoimmune response attacking the enterocytes and causing the villous atrophy.

What are the symptoms?

Celiac disease has a variety of classical symptoms relating to problems with the gastrointestinal tract. Symptoms including diarrhea, intestinal bloating, and cramps, and these are often the first, most urgent responses to gluten ingestion. Other symptoms can include irritability and weight loss as the body’s nutrient uptake system fails.

Anemia and other nutrient deficiencies are commonly related to untreated CD. Many of these symptoms mimic other conditions such as irritable bowel syndrome, lactose intolerance, or diverticulosis, which can add to the complications in diagnosing CD. In children, lack of nutrient absorption may cause delays in growth and the onset of puberty, vomiting, irritability, changes in behavior and, of course, problems with the enamel on their teeth.

According to Dr. Fasano’s study, CD has a prevalence of approximately 1 in 133 people. First and second degree relatives of diagnosed individuals have a 1 in 22 chance and 1 in 39 chance respectively of also having CD.

CD can remain largely dormant for many years, but among genetically susceptible individuals it can appear at any time during their lives. Stress, pregnancy, surgery, or even infections may cause the onset of severe symptoms. CD does not discriminate and occurs on all continents, and among all racial, cultural, and age groups.

How is celiac disease diagnosed and treated?

Several blood tests have been developed to help screen for CD. Testing serological samples for anti-gliadin antibodies, the AGA test; endomysial antibodies, the EMA test; anti-tissue transglutaminase antibodies, the anti-tTG test; and deamidated gliadin peptide antibodies, the DGP test, can all be used to support a diagnosis and the need for further testing. But there is only one conclusive test that physicians rely on — conducting an intestinal biopsy and examining the damage to the villi.

Diagnosis can be difficult, and many celiac associations report that some people have sought the help of three or more doctors, and spent several years suffering before finally being diagnosed.

CD is unusual in the spectrum of autoimmune disorders because of what is known about it. Dr. Fasano’s research has revealed the three main ingredients in the disease pathogenesis:


  1. Genetic susceptibility
  2. Leaky gut
  3. Environmental trigger (gluten)

Remove any one of these three and the condition should go away. Researchers are working on drug therapies to plug the leaky gut, but there is currently only one known treatment for CD – eliminating the environmental trigger by maintaining a strict adherence to a gluten-free diet. Any ingestion of gluten will cause illness, and as the 1989 study showed, continued ingestion increases the chance of other diseases developing.

Gluten is the combination of two proteins, glutenin and gliaden, that occur in cereal grains such as wheat, barley, and rye. Glutenin and gliaden exist independently within the whole head of the grain, but become combined into gluten when moisture is added.

When cereal grain flours are mixed with water to form dough, the combined proteins form into longer chains of stretchy molecules. Gluten provides the structure and support for trapping gasses during the rising process. Baking dries and sets the final product, but the gluten remains.

Gluten itself can be extracted from grain, and has been developed into a commercially available product that may be used as an additive in a variety of items including food, cosmetics, and dental hygiene products.

How can dental professionals respond?

Dr. Malahias says dental product companies have responded well to the need for gluten-free, and if patients or dentists aren’t sure, they can check the labels on their inventory.

“Everything is labeled now,” he said. “Before, you had no idea what was in a lot of polishing pastes. Now they are labeled gluten-free, preservative-free, saccharine-free. They list this. They specifically list gluten-free now.”

Dr. Malahias also recommends that dentists add celiac disease to their medical history questionnaires. He says all patient questions should be treated seriously, and all concerns should be addressed with the understanding that these people are suffering from a very serious illness.

“The last thing [a patient] wants is to get sick again by something you put in their mouth,” he said.

Dr. Malahias now speaks around the country, telling other dental professionals about the connection confirmed by his study. He has also started appearing at celiac education events to further get the word out. He is very interested in seeing his peers become knowledgeable on this subject because their clinical suspicions may be the first step in directing patients to physicians who can properly diagnose, or rule out, CD.

“Because we see the tissue and we see the health of the tissue, we can advise patients to go see their physicians,” he said. “[Dentists] can’t diagnose celiac disease, and you can’t say everyone with dental enamel defects has celiac, but you should at least think about it.”

Dr. Malahias’s complete study and more information on celiac disease and the dental patient can be found on his office’s website at http://www.bridgeworksfdc.com/page.php?t=celiac.

Christopher Friesen is a professional technical and freelance writer. His work has appeared in Connector Specifier Magazine, The Journal of Commerce, the Winnipeg Free Press, and Radio World Magazine. He and his wife publish the gluten-free recipe website, http://www.thebakingbeauties.com.


1. Holmes GK, Prior P, Lane MR, Allen RN. “Malignancy in celiac disease – effect of a gluten-free diet.” Gut, 30(3):333-338; 1989.
2. Cheng J, Malahias T, Brar P, Minaya MT, Green PH. The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States cohort. J Clin Gastroenterol. 2010 Mar;44(3):191-4. doi: 10.1097/MCG.0b013e3181ac9942.
3. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.


From Water to Ice in an instant…. perfect for a summer’s solstice!

I thought this was really cool, but see the video for yourself!

Whoa, Watch Bacteria Instantly Turn Water Into Ice

Believe it or not, making ice is more complicated than just making water really cold. One thing that helps is bacteria. Yes, bacteria! In this captivatingly magic video, it takes just a second forPseudomonas syringae to turn a whole jar of water into ice.

How does it work? It’s the same principle behind how snow forms in the atmosphere (and in artificial snow machines, too—we’ll get to that later). An ice crystal needs to form around a nucleus, which can be a bit of dust, soot, pollen, or, as we’ve seen, bacteria. Pure water doesn’t have to crystallize into ice until it’s as cold as 55 F below zero. In the demo here, the water has been supercooled to about 21 F, but it only freezes over after the P. syringae is added.

Maggie Koerth-Baker, who first spotted the video for Boing Boing, explains where P. syringae’s cold superpower comes from.

P. syringae gets this skill from the proteins that cover its surface membrane. The proteins basically form a physical structure that water molecules latch onto. That structure also orients the molecules in a way that prompts the formation of ice crystals. It’s these proteins that really serve as the instigator of ice nucleation and they’re incredibly efficient at it — far more so than dust…
Commercial snow machines use the proteins (though not the bacteria itself) to help instigate the creation of snow on ski mountains.

In its earthbound life, P. syringae causes disease in plants, so its snow-forming ability might seem bizarre. One hypothesis is that ice nucleation is really a subtle means of hacking the weather system: bacteria drifts up into the atmosphere and falls back to earth as snow and hail, traveling hundreds of miles in between.

We humans might think ourselves clever using bacteria proteins to make artificial snow for ski resorts, but the microbes have been way ahead of us. [Mark Martin via Boing Boing]

Artistic food deemed tastier, scientists and chef show

Science and art of plating


CBC News Posted: Jun 20, 2014 2:04 PM ET Last Updated: Jun 20, 2014 2:07 PM ET

Diners prefer a visually attractive dish, say it tastes better and they’ll pay more for it, an experiment cooked up by a chef suggests.

Psychologists and food scientists tested an idea favoured by some top chefs:  the visual sensation of an edible culinary masterpiece can enhance a diner’s experience of a dish.  We do taste with our eyes first.

Art-inspired salad

Researchers arranged a salad (right) to resemble artist Wassily Kandinsky’s Painting number 201 (left) and found that people rated it as tastier, and were willing to pay more for it. ( Artists Rights Society (ARS)/ADAGP and journal Flavour)

Franco-Colombian chef Charles Michel was classically trained in French cuisine. During a visit to the Museum of Modern Art in New York, Michel was inspired by Russian abstract artist Wassily Kandinsky’s Painting #201.

“I realized how beautiful the colours and the movements and the lines were and kind of immediately, I thought this could be a salad. These beautiful colours could be a salad,” Michel recalled in a Skype interview.

“The small text of the painting said that colour is a means of exerting direct influence upon the soul. I had that seed of inspiration, an epiphany there watching the painting and then started doing this Kandinsky-inspired dish in my events.”

Prof. Charles Spence of Oxford University came to one of Michel’s events and the experiment was born.

Michel arranged a salad in one of three presentations:

  • Simply plated with all of the elements of the salad tossed together.
  • Elements arranged to look like one of Kandinsky’s paintings.
  • Elements were organized in a neat but non-artistic manner.

The salads had a total of 30 ingredients, including seared portobello mushroom slices, cooked and raw broccoli sprouts, a variety of endive salad, raw red and yellow pepper cut into fine brunoises, beet and carrot purée and Spanish olive oil.

AGO Chef Jeff Dueck

People do taste with their eyes, says Jeff Dueck, head chef at the Art Gallery of Ontario. (Kas Roussy/CBC)

During the study, 60 volunteers aged 18 to 58 were given just one salad each to rate before and after lifting a fork.

“People intuitively recognized the artistic presentation as being more complex and more artistic and they liked it more,” Michel said.

Participants were also willing to pay more for the Kandinsky-inspired plating, the researchers said in Friday’s issue of the journal Flavour.  The diners also gave a higher rating to the tastiness of the painting version.

CBC News asked Jeff Dueck, head chef at the Art Gallery of Ontario, to help recreate the experiment. His inspiration was Autumn Foliage by Group of Seven artist Tom Thomson.

Dueck said he think the expectations and heightened interest of an art-inspired dish makes the flavours come alive.

“We’ve had dinners like this with other artists and people have come and paid to be in that evening and to experience the food in a different setting . It does work,” said Dueck.

New “superfood” …. You will never guess


Watercress Tops Ranking of Nutrient-Dense Foods

CDC compiles list of “powerhouse fruits and vegetables.”


Scott Douglas


June 9, 2014

Step aside, kale and blueberries. According to a new ranking of what it calls “powerhouse fruits and vegetables,” the Centers for Disease Control and Prevention says that the humble green watercress is the most nutrient-dense produce item.

Jennifer Di Noia, Ph.D., of William Patterson University in New Jersey, created the ranking by starting with a list of potential produce powerhouses. The initial list was based on literature that identified leafy greens, yellow/orange vegetables, citrus fruits and cruciferous vegetable as being associated with reduced chronic disease, and berry and allium vegetables as being associated with reduced risk for cardiovascular and neurodegenerative disease, and some cancers.

For each of the 47 foods she selected, Di Noia created a nutrient-density score, based on the percentage of recommended daily value of 17 nutrients each contains per 100 grams. The percentage of daily value for each nutrient was capped at 100, so that no one nutrient would outweigh others (and so that a food that’s exceptionally high in one nutrient but lacking in many others wouldn’t be classified as nutrient-dense). Among the nutrients considered were iron, vitamin C, fiber, zinc and folate.

Each food’s score represents the average of percent daily values per 100 calories; the best a food could score was 100. Di Noia counted a food as a powerhouse if it scored 10 or higher.

Using this system, watercress came out on top as the most nutrient-dense fruit or vegetable, with a score of 100. It was followed by Chinese cabbage (91.99), chard (89.27), beet greens (87.08) and spinach (86.43). Kale, with a score of 49.07, ranked 15th. A screen grab of the first part of the nutrient-density ranking is below. The full list is available here.

Six foods Di Noia considered, including blueberries and raspberries, didn’t get a “powerhouse” ranking. Berries are often touted for their phytochemical content, or chemical compounds such as antioxidants that are thought to impart health benefits but that aren’t considered essential nutrients. “Because it was not possible to include phytochemical data in the calculation of nutrient density scores, the scores do not reflect all of the constituents that may confer health benefits,” Di Noia wrote.

The CDC ranking is meant to help guide food choices and to encourage eating a wide variety of nutrient-dense foods, rather than have watercress become the new national food obsession. That said, because many people are relatively unfamiliar with watercress, below are a few watercress recipes to get you started. A full list, as well as recipes for other nutrient-dense foods, are available at the Rodale recipe finder.

Watercress and Walnuts with a Citrus Vinaigrette

Salmon with White Beans and Watercress

Romaine and Watercress Salad with Anchovy Vinaigrette

Eat right, sleep better

5 Foods That Help You Sleep

by Kristin Kirkpatrick, MS, RD, LD


Let’s face it — we live in a non-stop society. In our rush, we too often put sleep on the back burner. As a busy mom myself, I can understand why people forgo sleep to get things done. 

But it’s the wrong approach. Sleep has a huge effect on how you feel throughout the day, and nutrition plays a role in how well you sleep. Food relates directly to serotonin, a key hormone that — along with Vitamin B6, B12, and folic acid — helps promote healthy sleep. Try to consume foods that calm the body, increase serotonin levels and get you ready for restful sleep.

Here are a few foods to get you started on the path to slumber.

1. Complex carbohydrates

Embrace whole-grain breads, cereals, pasta, crackers and brown rice. Avoid simple carbohydrates, including breads, pasta and sweets such as cookies, cakes, pastries and other sugary foods. These tend to reduce serotonin levels and do not promote sleep.

2. Lean proteins

Lean proteins include low-fat cheese, chicken, turkey and fish. These foods are high in the amino acid tryptophan, which tends to increase serotonin levels. On the flipside, avoid high-fat cheeses, chicken wings or deep-fried fish. These take longer to digest and can keep you awake.

3. Heart-healthy fats

Unsaturated fats will not only boost your heart health but also improve your serotonin levels. Examples include peanut butter (read the label to make sure peanuts are the only ingredient) and nuts such as walnuts, almonds, cashews and pistachios. Avoid foods with saturated and trans fats, such as french fries, potato chips or other high-fat snack foods. These bring your serotonin levels down.    

4. Beverages

Certain drinks can promote or prevent sleep. A good, soothing beverage to drink before bedtime would be warm milk (your mother was right) or herbal tea such as chamomile or peppermint. As for caffeinated drinks, I recommend that my clients who are having difficulty sleeping consume that last cup by 2 p.m. caffeine can affect people differently, and even the smallest amount of stimulant can keep you awake. 

5. Fresh herbs

Fresh herbs can have a calming effect on the body. For example, sage and basil contain chemicals that reduce tension and promote sleep. Trymaking your own homemade pasta sauce with sage and basil. It’s easy to do, and homemade sauces tend to be lower in sugar than store-bought versions. However, avoid herbs such as red pepper or black pepper at night, as they have a stimulatory effect.

Sleep-inducing snacks

Try a banana with low-fat yogurt Eat low-fat cottage cheese with a few 100-percent whole grain pita chips smear peanut butter on 100-percent whole grain crackers Enjoy an apple with mozzarella string cheese.

 Try all these foods to reduce your tossing and turning when you hit the pillow. Sweet dreams!

4 Ingredient Homemade Orange Julius (Dairy-Free)

Sounds good to me! my own orange julius in the comfort of my home


Homemade Orange Julius Recipe Hip2Save[h2s_pinit src=”http://h2savecom.files.wordpress.com/2014/06/homemade-orange-julius-recipe-hip2save.jpg” align=”http://none” /]

If you’re craving a cold and creamy Orange Julius drink, try this easy homemade and healthier non-dairy version perfect for the hot summer weather!  I love that this recipe uses fresh oranges instead of sweeteners, and the frozen bananas eliminate the need for ice and make it extra smooth and creamy.

Homemade Orange Julius


3 ripe oranges, peeled
2 frozen bananas
1 and 1/2 cup almond milk or milk of choice (I used the vanilla almond variety and loved it!)
1 teaspoon vanilla

healthier Orange Julius Recipe


Blend all ingredients in a high powered blender until smooth and frothy. Makes about 3 servings. The key is using really ripe sweet oranges so that no sweetener is needed. Enjoy 🙂

Orange Julius Recipe Hip2Save

[h2s_box]Written by Lina for Hip2Save. Lina is a proud mom of 2 small kids who loves photography, all holidays, cooking, thrift store makeovers, bargain shopping, and DIY makeovers. Her goal is…

View original post 25 more words

Great Legs, Gross Teeth: Endurance Runners and Tooth Decay

Runners are sexy people. They have a contagious energy, an unusually positive outlook on life, and let’s face it — they look good in their spandex shorts. But, according to dentists and health professionals, runners and other endurance athletes are more prone to tooth decay and dental problems than the rest of the population. Here’s what you need to know about runners and tooth decay.

Sports Drinks
Sports drinks like Gatorade, Powerade and Accelerade contain lots of sugar. Simple sugars are used to fuel our muscles during races and training. Sugars are absorbed quickly and preserve muscle glycogen to extend athletic endurance and help us run farther. However, the sugars that help our tired muscles are hurting our teeth.

They have bodies of Adonis and a garbage mouth. — Paul Piccininni, Dental Director for the International Olympic Committee

To make matters worse, most sports drinks contain phosphoric or citric acid which erode tooth enamel. The compromised tooth then becomes more susceptible to bacterial build-up fueled by the sugary liquid. Bacterial proliferation leads to plaque, cavities, gingivitis, and a host of other dental problems.

Dry Mouth
Runners are heavy breathers. If you’ve ever run a race, you’re familiar with the freight train sound of runners gasping for oxygen. All that rapid breathing dries out the mouth, reduces saliva flow, and gives bacteria a great place to live. And that sports drink you sip as directed, delivers just enough sugar to keep things moving in terms of bacteria production.

How Runners Can Prevent Tooth Decay
So what can you do? You work hard to keep your body in peak physical condition, you eat healthy foods, and you fuel during your races as directed by the experts. Here’s how to keep your teeth as healthy as the rest of your body and have a winning smile:

  1. Rinse your mouth with water after consuming gels, bars, or sports drinks. Often times the aid stations will have a choice of sport drink or water. Take one of each and ‘rinse and spit’ with water.
  2. Chew gum when you can to increase salivary flow and neutralize the bacteria in your mouth. The gum should contain xylitol.
  3. Brush and floss regularly.
  4. Ask your dentist about sealants and fluoride treatments. Let them know you’re an endurance athlete and discuss ways to prevent tooth decay.

Coffee Could Lead to Healthy Teeth

Coffee Could Lead to Healthy Teeth.


There may be a newly discovered benefit to drinking coffee.

Recent studies suggest that regularly drinking coffee keeps teeth healthy and clean. The information was determined by a team at the Federal University in Rio de Janeiro.

The caffeine helps to eliminate harmful bacteria and plaque.

The researchers looked at baby teeth containing the robusta coffee bean, which is grown in Brazil and Vietnam. They concluded that the bean aided in getting rid of a film of bacteria on the teeth, serving to thwart the onset of plaque.

The information could be vital because plaque is a top cause of gum disease and decay and any substance that can battle plaque is something beneficial. Specifically, the polyphenols in the bean break down the bacteria film, which lower the risk of the formation of plaque.

Despite the results of this study, it is still not recommended to drink a copious amount of coffee. Consuming coffee can still stain teeth and, when consumed with some milk or sugar, the coffee may raise the risk of enamel erosion.

Vitamin D and HIV Progression


Vitamin D Deficiency When Starting Treatment Linked With Increased HIV Progression



June 9, 2014

Having low levels of vitamin D when starting treatment is associated with a more than doubled risk of HIV progression, virologic failure and death, according to a recent study published in The Journal of Infectious Diseases.

The study followed 1,571 treatment-naive patients in Brazil, Haiti, India, Malawi, Peru, South Africa, Thailand, the United States and Zimbabwe. The primary endpoint was progression to WHO (World Health Organization) stage 3/4 or death within 96 weeks of starting treatment. The secondary endpoint was virologic failure (defined as two consecutive viral loads above 1,000 copies/mL after 16 weeks of starting treatment).

The researchers compared levels of baseline vitamin D to see if there was an association with increased disease progression. Data on possible vitamin D supplementation was not collected, but the researchers noted that supplementation was not common and was unlikely to have occurred in resource-limited settings.

Aidsmap.com reported:

Almost half (49%) of all participants in the study had low vitamin D concentrations at baseline. Prevalence of low vitamin D varied between countries, ranging from 27% in Brazil to 78% in Thailand and 72% in India. Prevalence was 92% among African-Americans in the US.

After controlling for country and HIV treatment regimen, the factors significantly associated with low vitamin D were race, season of sampling (winter/spring), high or low body mass index (BMI) and lower HIV viral load.

Analysis that took into account history of previous AIDS-defined illness and controlled for season, baseline CD4 count and viral load, BMI and race showed that low vitamin D concentrations at the start of therapy were associated with a twofold increase in the risk of clinical disease progression (HR = 2.13; 95% CI, 1.09-4.18).

Given the results, the researchers concluded that low vitamin D levels are “common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure,” as well as HIV progression and death. They noted that further studies are needed to examine the potential benefit of vitamin D supplementation among people starting treatment.

Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.

Follow Warren on Twitter: @WarrenAtTheBody.