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The following g slides are a gra g p phic representation of the material pr presen esent te ed d in in Re Rep

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Seaton

• n’s

s St Sta at te e of

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Reform 2014 booklet which can be found online at: http://akhouse.org/rep_seaton/

State of Reform 2014

Representative Paul Seaton

Evidence Based Medicine?

Worsening Severity of Vitamin D Deficiency is Associated with Increased Length of Stay, Surgical Intensive Care Unit Cost, and Mortality Rate in Surgical Intensive Care Unit Patients – American Journal of Surgery, Matthews, et. al. 2012

Survival

HospitalizedDays HospitalizedDays

Treatment Costs

Grady Memorial Hospital Atlanta, Georgia

Treatment Costs Per Patient 60% Lower Lower

14

Incidence of In‐Hospital Mortality and Cardiovascular and Infectious Morbidities for 3409 Noncardiac Surgical Patients by Quintiles of Serum Vitamin D Concentrations

Anesthesia Patient Safety Foundation ‐ The Association of Serum Vitamin D

12

f y Concentration with Serious Complications after Noncardiac surgery – Turan

• et. al. September 2014

Mortality

10

cidents

Mortality Cardiovascular Infectious

6 8

entage of Inc

Infectious

4

Perce

2 1 2 3 4 5

Vitamin D Serum Levels

<13ng/ml 13.1‐20.4ng/ml 20.5‐27.3ng/ml 27.4‐36.2ng/ml >36.2ng/ml

Treatment with Oral Active Vitamin D is Associated with Decreased Risk of Peritonitis and Improved Survival in Patients on Peritoneal Dialysis

Kerschbaum et al PLOS ONE July 2013 100%

Peritoneal Dialysis ‐ Kerschbaum et. al. PLOS ONE, July 2013

57% Reduced Incidence 54% Reduced Incidence 49% Reduced Incidence 66% Reduced Incidence 16% Reduced Incidence

80%

isk

60%

ve Ri

40%

Relati

No Vitamin D

20%

R

Treatment Regime Received Oral Vitamin D

1st Episode Peritonitis All ‐ Cause Death Gram‐Positive Peritonitis Gram‐Negative Peritonitis Sterile Peritonitis

Treatment with Oral Active Vitamin D is Associated with Decreased Risk of Peritonitis and Improved Survival in Patients on Peritoneal Dialysis ‐ Kerschbaum et. al. PLOS ONE, July 2013

Other Outcomes

Months to first episode of peritonitis with no oral active vitamin D: 5.5 Months to first episode of peritonitis with oral active vitamin D: 16.3 Episodes of peritonitis per patient‐year with no oral active vitamin D: 0 45 Episodes of peritonitis per patient‐year with no oral active vitamin D: 0.45 Episodes of peritonitis per patient‐year with oral active vitamin D: 0.29

TYPE 2 DIABETES

48 48 ng/ml 22 / l ng/ml

Type 2 Diabetes Incidence in GrassrootsHealth (N=4,933) and NHANES (N=4,078 Cohorts

79% Lower

22 22 ng/ml 41 ng/ml Median 25 (OH)D concentration in GRH cohort was 41 ng/ml and in NHANES was 22 ng/ml Median 25 (OH)D concentration in GRH cohort was 41 ng/ml and in NHANES was 22 ng/ml Data from GrassrootsHealth presentation at the June 2014 International Vitamin D Workshop

Recommended Daily Dose in Finland Cohort Study: 2000 IU in first year of life

80% Lower Lower

Vitamin D and the risk of dementia and Alzheimer disease Neurology published online August 6, 2014

Clear Link Found Between Vitamin D Deficiency and Alzheimer’s Disease Yahoo Health

• Yahoo! Health

S l D fi i

Alzheimer s Disease – Yahoo Health

Severely Deficient Deficient Severely D fi i Sufficient Deficient Deficient Sufficient Notes by the office of Rep. Seaton

Vitamin D level at first episode psychosis

Crews, M. et. al. Vitamin D deficiency in first episode psychosis: A case‐control study – Schizophrenia Research (2013)

p p y

• vs. control group

ml

30

el in ng/m

Combined Relative Risk of being Vitamin D deficient is 2.99 times higher in first episode psychosis

n D Leve

20 g/ml

n Vitamin

10 4 ng/ml 26.8 ng ml g/ml /ml 6 ng/ml

Mean

18.4 .7 ng/ml 14.3 ng/ 0.1 ng/ml 15.7 ng 14.7 ng/ 21.6 White N= 39 9. Black N=20 1 Asian N=10 All N=69

Association of Serum 25‐Hydroxyvitamin D with Symptoms of Depression after 6 months in Stroke Patients – Neurochemical Research, August 2014, Wei Yue et. al.

Odds Risk for Post Stroke Depression (PSD) increased by 21.12 times if vitamin D levels were below 11.2 ng/ml and still increased 10.32 times when fully adjusted for all confounders – notes by office of Representative Paul Seaton

5

s

Breast Cancer Relation to Vitamin D

2014 Preliminary GrassrootsHealth Data at 1 1/2 Year Follow‐Up 0f 844 Women O 60

4

rson‐Years

Over 60

Median of 50 ng/ml

3

1,000 Per

82% Risk Reduction

2

ncers Per

1

New Can

2007 ‐ 2011 Alaska Breast Cancer Rate Study Rate <50ng/ml Study Rate >50ng/ml

Hazard ratio of breast cancer for those with serum 25(OH)D <50ng/ml was 5.1 times more compared to those with > 50ng/ml, adjusting for age and BMI. Chart arranged by the office of Representative Seaton

GrassrootsHealth Prospective Study 2009‐2014 From Grassroots Health and U.C. San Diego

Anticancer Research, March 2014

2014 Mohr et. al.: 25‐Hydroxyvitamin D and Survival in Breast Cancer Cancer 50% Lower 50% Lower Mortality Risk

Anticancer Research 2014 Mar;34(3):1163‐6. Meta‐analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Mohr SB1, Gorham ED, Kim J, Hofflich H, Garland CF.

US A

Low Serum 25 Hydroxyvitamin D level and Risk of Upper Respiratory tract infection in Children and Adolescents Science et. al. Journal of Clinical Infectious Diseases, August 2013 volume 57. Slide prepared by the office of Representative Paul Seaton

US Average