Anemia, a condition defined by deficiency in the size or number of red blood cells (RBCs), or a lower-than-normal level of hemoglobin within the RBCs, is a multifactorial condition whereby numerous factors may contribute to its development. The main factors include inadequate nutrition, poor nutrient absorption, deficiencies in essential micronutrients, nutritional interactions, infections, inflammation, chronic diseases, gynecological factors, heavy menstrual cycles, hemorrhage, pregnancy complications, family history of anemia and inherited disorders affecting RBCs. Anemia remains a significant public health concern, with the most vulnerable being children under five, specifically infants and young children below the age of 2 years, adolescent girls, women of reproductive age (WRA) and pregnant women. While symptoms of anemia vary depending on its severity, common symptoms include fatigue, dizziness, shortness of breath, chills at the extremities (hands and feet), headache, palpitations, decreased physical endurance, inadequate nutrition, and reduced productivity. Anemia predominantly affects low-income and middle-income countries with the heaviest burden, specifically populations residing in rural areas, economically disadvantaged households, and those lacking formal education. In 2019, the World Health Organization (WHO) estimated that approximately 40% of under five children, 37% of pregnant women, and 30% of WRA (15–49 years of age) worldwide are anemic. In the Eastern Mediterranean Region (EMR), the prevalence among under five children ranged between 11.9% and 79.5%. Among WRA, the prevalence ranged from 23.7% to 61.5%, while the prevalence among pregnant women was estimated between 19.1% and 57.5% in countries of the region. When the prevalence was assessed based on income, data from the region showed that in general, as income increased, the prevalence of anemia, and subsequently its severity, decreased, even though some exceptions were present in few countries. When the severity of anemia was assessed, the majority of EMR countries fell into the moderate category for anemia, with a prevalence rate ranging between 20% and 39.9% among under five children, WRA and pregnant women. The majority of EMR countries are therefore off track when compared with the World Health Assembly (WHA) global target of reducing anemia by 50% among WRA in 2025. The management and prevention of anemia should be specific in targeting the underlying nutritional and non-nutritional causes of anemia. This includes following a healthy, nutritious and diversified diet; improving infant feeding practices and promoting exclusive breastfeeding; considering supplementation if necessary; implementing food fortification policies; implementing nutrition education and awareness programs; enforcing food security and ensuring adequate access to a healthy, nutritious and diversified diet, across the population; targeting non-nutritional causes of anemia through specific programs pertinent to malaria, HIV, tuberculosis, soil-transmitted parasitic worms, genetic blood disorders, water, sanitation and hygiene (WASH), environmental and social aspects, delayed cord clamping, birth spacing, and menstrual bleeding and hemorrhage. Therefore, multifaceted, holistic and comprehensive approaches to address the key contributors to anemia are a must, along with frequent monitoring, evaluating and impact assessment. Key recommendations highlighted in the regional expert consultation 2023, on prevention and management of anemia in the EMR, focused on the following: defining a holistic approach; advocacy, coordination and communication; nutrition, dietary habits and preferences; nutrition education; providing support; school-based approaches; data collection, assessment, revision and monitoring; data quality/reporting and analysis; and coverage of interventions.

Vitamin D is an essential, fat-soluble micronutrient that is either naturally present in few foods, added intentionally to some foods or found in dietary supplements. It plays numerous vital roles in the maintenance of the organ systems in the human body, in addition to its known role in bone health maintenance by facilitating the absorption of calcium and phosphorous. Vitamin D deficiency (VDD) has become a major public health concern, particularly in countries undergoing a rapid nutrition transition with a shift in dietary habits and lifestyle, characterized by high consumption of processed foods, and an indoor lifestyle. VDD has shown implications on nutrition and health, including bone health, myopathy, diabetes, depression, as well as implications during pregnancy. The most vulnerable to VDD are infants, pregnant teenagers and women, older adults, people with limited sun exposure, people with darker skin, people with reduced fat absorption, obese people, people who underwent gastric bypass surgeries and vegans. Moreover, not only does VDD have health consequences, but so does excessive levels of vitamin D in the body. In fact, vitamin D toxicity has been associated with hypercalcemia, calcification of soft tissues, fatigue and irritability, irregular heart rhythms, renal failure and in some cases mortality.Although the daily needs of vitamin D can be met by sun exposure, VDD remains prevalent globally. As for the Eastern Mediterranean Region (EMR), and according to the most recent national and regional data, VDD was found to be prevalent, with its prevalence ranging between 8% and 81% among under five children, between 16.2% and 95.5% among women of reproductive age (WRA) and between 13.6% and 93.9% among pregnant women.Globally, the treatment and management of VDD includes promoting a healthy, diverse and nutritious diet; supplementation, after consulting with the physician or healthcare practitioner; ensuring appropriate food fortification; ensuring sufficient sun exposure; providing awareness programs and proper education; involving the food industry at the level of product reformulation; supporting research to assess and oversee the impact of supplementation programs and fortification strategies in practice. While some countries and regions in the EMR, such as Lebanon and the Gulf Cooperation Council (GCC), have developed their own guidelines, the general recommendations for vitamin D in the EMR highlight the following three key points: 1) promoting reasonable sun exposure, encouraging healthy eating habits and enforcing fortification within safe margins; 2) testing for VDD is only recommended for symptomatic individuals and those at risk; and 3) no recommendations are present for population-wide screening for low vitamin D levels.

An enormous food and agricultural waste are produced annually around the globe. Waste arising from food and agricultural sectors has the potential of vast application. India is one of the largest agricultural-driven 166countries with diverse geographical regions with varying climates around the year. Harvesting of agricultural produce is either followed by the processing of the fresh produce or storage for later consumption. All these activities result in a vast generation of waste in terms of crop residue or food waste. In countries like India, the generation of consumable and non-consumable agricultural wastes throughout the supply chain, from farm to the consumer, is very tremendous. Various studies carried out by the National Engineering and Environmental Research Institute (NEERI), Nagpur; Central Pollution Control Board (CPCB), New Delhi; Central Institute of Plastics Engineering and Technology (CIPET), Chennai; and Federation of Indian Chambers of Commerce and Industry (FICCI), New Delhi, have suggested an increasing trend of the waste generation by the urban sector including the household waste and the other solid wastes. Globally, around 1.3 billion tons of food, which count to about 33% of the edible food, is being discarded during the entire food supply chain (FSC). Incineration of agricultural residue, dumping, and burial of the solid and the other food industrial wastes has resulted in large-scale land, water, and air contamination. Serious environmental degradation and alarming situation has forced the governments to take concrete measures in order to overcome/reduce the wastage and enhance the feasible management practices for the conversion of non-edible/waste material into functional products and energy. Though, efficient execution of these methods needs strong policies and strategies in addition to other socio-economic factors. This chapter addresses the essential technological aspects, possible solutions, and sound policy concerns to accomplishing long term way out of waste management (WM) and to minimize the negative impact of waste on the environment.

The pathophysiology of coronavirus disease-19 (COVID-19) is characterized by worsened inflammation because of weakened immunity, causing the infiltration of immune cells, followed by necrosis. Consequently, these pathophysiological changes may lead to a life-threatening decline in perfusion due to hyperplasia of the lungs, instigating severe pneumonia, and causing fatalities. Additionally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause mortality due to viral septic shock, resulting from unrestrained and backfiring immune reactions to the pathogen. Sepsis can cause premature organ failure in COVID-19 patients, as well. Notably, vitamin D and its derivatives and minerals, such as zinc and magnesium, have been reported to improve the immune system against respiratory illnesses. This comprehensive review aims to provide updated mechanistic details of vitamin D and zinc as immunomodulators. Additionally, this review also focuses on their role in respiratory illnesses, while specifically delineating the plausibility of employing them as a preventive and therapeutic agent against current and future pandemics from an immunological perspective. Furthermore, this comprehensive review will attract the attention of health professionals, nutritionists, pharmaceuticals, and scientific communities, as it encourages the use of such micronutrients for therapeutic purposes, as well as promoting their health benefits for a healthy lifestyle and wellbeing.

Vitamin D deficiency is highly prevalent in India and worldwide. Mushrooms are important nutritional foods, and in this context shiitake (Lentinula edodes), button (Agaricus bisporus) and oyster (Pleurotus ostreatus) mushrooms are known for their bioactive properties. The application of ultraviolet (UV) irradiation for the production of substantial amounts of vitamin D-2 is well established. Levels of serum 25-hydroxy vitamin D (25-OHD), parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) were significantly (p < 0.05) improved in vitamin-D-deficient rats after feeding with UVB irradiated mushrooms for 4 weeks. Further, microscopic observations indicate an improvement in the osteoid area and the reduction in trabecular separation of the femur bone. In addition, the level of expression of the vitamin D receptor (VDR) gene and genes metabolizing vitamin D were explored. It was observed that in mushroom-fed and vitamin-D-supplemented groups, there was upregulation of CYP2R1 and VDR, while there was downregulation of CYP27B1 in the liver. Further, CYP2R1 was downregulated, while CYP27B1 and VDR were upregulated in kidney tissue.

Vitamin D is a lipophilic molecule, thus susceptible to ultraviolet light, oxygen and processing conditions. The poor stability and dispersibility in food matrices make it further unavailable in the low-/nonfat foods. In this study, a low temperature aided sonication method was used for incorporating vitamin D3 in the oil-in-water emulsion. The emulsion system was fabricated by blending medium-chain triglyceride (MCT), ethylene glycol (EG), Kolliphor-RH-40 (KRH-40), vitamin-D3 and aqueous phase, followed by optimization using Box Behnken design (BBD) tool of Response Surface Methodology (RSM). The RSM revealed that the sonication time of 30 s, stirring rate of 1500 rpm, mixing time of 10 min, 600 mu L of KRH-40, 100 mu L of MCT and 400 mu L of EG produced the optimum nanoemulsion with mean particle size (169 nm), zeta potential (-22.6 mV), turbidity (1.78) and encapsulation efficiency (91%). Differential scanning calorimetry thermograms and Fourier transform infrared spectra indicated no chemical interaction between active component and surfactants. Scanning electron mi-croscopy revealed irregular shapes. HPLC results indicated a slight decrease (3000 +/- 130.58 IU to 1703.66 +/- 28.09 IU) in vitamin D3 concentration over three months of storage. The fabricated nanoemulsion will open new horizons in the fortification of vitamin D in non-/low fat food matrices.

Purpose The purpose of this study was to optimize the parameters for enhancing the vitamin D2 formation in three edible mushroom varieties, namely, shiitake mushroom (Lentinula edodes), white button mushroom (Agaricus bisporus) and oyster mushroom (Pleurotus ostreatus) using ultraviolet (UV) irradiation. Design/methodology/approach Freshly harvested mushrooms were irradiated with UV-B and UV-C lamps. Further, mushrooms were treated with UV-B at a distance ranging between 10 and 50 cm from the UV light source, for 15–150 min, to maximize the conversion of ergosterol to vitamin D2. Analysis of vitamin D2 content in mushrooms before and after UV exposure was done by high pressure liquid chromatography (HPLC). Findings HPLC results showed a significant (p < 0.001) increase in vitamin D2 levels of shiitake (17.3 ± 0.35 µg/g), button (24.9 ± 0.71 µg/g) and oyster (19.1 ± 0.35 µg/g) mushrooms, irradiated with UV-B at a distance of 20–30 cm for 120 min. Further, stability studies revealed that vitamin D2 levels in UV-B-irradiated mushrooms gradually increased for 48 and 72 h of storage at room and refrigeration temperatures, respectively. During cooking operations, 62%–93% of vitamin D2 was retained in UV-B-irradiated mushrooms. Originality/value This study describes the most effective parameters such as ideal wavelength, mushrooms size, duration of exposure and distance from UV sources for maximum vitamin D2 formation in edible mushrooms using UV irradiation. Further, assessment of vitamin D2 stability in UV exposed mushrooms during storage period and cooking operations has been carried out. In addition, this study also provides a comparison of the vitamin D2 levels of the three widely cultivated and consumed mushroom varieties treated simultaneously under similar UV exposure conditions.

COVID-19 has errupted not only as a pandemic but as challenge to mankind. Life has come to a stand still. All spheres of life are affected not only in terms of jobs and economy but importantly health and well being. In Indian scenario this is of particular significance as autumn coincides with festivities, wedding season and mass gatherings. Outbreaks of respiratory viral infections, such as those caused by influenza A and Respiratory Synctial Virus have long been associated with changing season reaching a peak in winter season and nadir in summer months. Various factors could be attributed to this pattern like increased virus survival at low temperature, tendency of close gatherings in winter months and cold dry air reducing mucus in nasal passages. Clinically Vitamin D deficiency has been shown to associate with increased risk of diverse acute respiratory tract infections. It has been proposed that vitamin D, diminishes production of respiratory cytokines, which appear to play a central part in pathogenesis of severe COVID-19.

Abstract Whey utilization has been a subject of much research, as it has a very high biological oxygen demand (BOD) and must be treated prior to disposal. Several strategies, such as isolation of whey proteins, bioconversions of lactose to ethanol, and methane production, have aimed at reducing the organic load for reducing the BOD levels. In order to enhance the utilization of whey, a novel approach for formulating a functional food was employed. Whey was blended with jamun juice to prepare whey jamun ice pops (WJP) by the use of freezing technology (−20°C) with the addition of small amounts of citric acid as preservative as well as for enhancing taste and nonnutritive sugar (sucralose). The formulation containing 59.7 ml of jamun pulp juice, 40.11 ml of whey, 0.06 g of citric acid, and 0.13 g of sucralose, which ranked best among all combinations, was selected. The formulation was analyzed for physicochemical parameters, total polyphenols, total flavonoids, and sensory acceptability. WJP was found to have 78% DPPH (2,2‐diphenyl‐1‐picrylhydrazyl) inhibition (antioxidant activity), 7.89 mg GAE/ml of total polyphenols, 4.58 QE mg/ml of total flavonoids, 0.7% (v/v expressed as citric acid) titrable acidity, pH 4.3, TSS 12 °Brix, 14.3 mg/100 ml vitamin C, and 6% reducing sugar. In the present study, in vitro antidiabetic activity showed inhibition of α‐amylase activity by 60%, and in vivo activity tested in albino rats revealed that the final product helped in regulating the blood glucose in the body.

Vitamin d-fortified bread has been proposed as a strategy to increase the average daily intake and serum status of this nutrient. This review aimed to bring together the different types of scientific articles on vitamin d-fortified bread. The databases used for the research were PUBMED, WEB of SCIENCE and SCOPUS; all original indexed studies written in English, published between January 2000 and March 2021, were considered. Three important points were identified: i) theoretical models of fortification; ii) stability, bioaccessibility, and bioavailability studies of vitamin d-fortified breads; and iii) clinical effects of vitamin d-fortified breads. This review showed that vitamin d-fortified bread is a promising vehicle for fortification strategy effects, leading to increased serum concentrations of 25(OH)D and decreased parathyroid hormone. However, further studies are needed to elucidate the effects and effectiveness of this fortification strategy in the prevention/treatment of vitamin D deficiency.

Adequate nutrition is essential for maintaining good oral health. Minerals such as magnesium, calcium, and phosphorus found in the diet constitute the main structural components of the tooth. Their inadequacy leads to absorption impairment, increased bleeding tendency, bone resorption, looseness, and premature tooth loss. Inadequacy of those essential minerals is associated with delayed tooth eruption and with enamel or dentin hypoplasia. Taking calcium without magnesium results in soft dental enamel, which cannot resist the acids causing tooth decay. In addition to magnesium, calcium, and phosphorus, adequate vitamin D is needed to maintain optimal oral health. Vitamin D exerts anti-inflammatory effects and helps in calcium absorption and bone remodeling. Moreover, adequate vitamin D status could reduce formation of dental caries by delaying its onset and progression. Here we summarize the oral manifestations of vitamin D and magnesium inadequacy.

The first incidence of COVID-19 was reported in the Wuhan city of Hubei province in China in late December 2019. Because of failure in timely closing of borders of the affected region, COVID-19 spread across like a wildfire through air travel initiating a pandemic. It is a serious lower respiratory track viral infection caused by highly contagious, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Coronavirus including COVID-19 causing SARS-CoV-2 causes zoonotic diseases and thought to be originated from bats. Since its first incidence, the virus has spread all across the world, causing serious human casualties, economic losses, and disrupting global supply chains. As with SARS-CoV, COVID-19 causing SARS-CoV-2 follows a similar path of airborne infection, but is less lethal and more infectious than SARS and MERS. This review focusses on the pathogenesis of SARS-CoV-2, especially on the dysfunctional immune responses following a cytokine storm in severely affected persons. The mode of entry of SARS-CoV-2 is via the angiotensin converting enzyme 2 (ACE-2) receptors present on the epithelial lining of lungs, gastrointestinal tract, and mucus membranes. Older persons with weaker immune system and associated co-morbidities are more vulnerable to have dysfunctional immune responses, as most of them concomitantly have severe hypovitaminosis D. Consequently, causing severe damage to key organs of the body including lungs and the cardiovascular system. Since, vast majority of persons enters to the intensive care units and died, had severe vitamin D deficiency, thus, this area must be investigated seriously. In addition, this article assesses the role of vitamin D in reducing the risk of COVID-19. Vitamin D is a key regulator of the renin-angiotensin system that is exploited by SARS-CoV-2 for entry into the host cells. Further, vitamin D modulates multiple mechanisms of the immune system to contain the virus that includes dampening the entry and replication of SARS-CoV-2, reduces concentration of pro-inflammatory cytokines and increases levels of anti-inflammatory cytokines, enhances the production of natural antimicrobial peptide and activates defensive cells such as macrophages that could destroy SARS-CoV-2. Thus, this article provides the urgency of needed evidences through large population based randomized controlled trials and ecological studies to evaluate the potential role of vitamin D in COVID-19.

Multiple myeloma (MM) is a plasma cell malignancy frequently accompanied with skeletal co-morbidity. Vitamin D (1,25(OH)2D) is an important mediator of skeletal homeostasis that mediates its effect by binding to vitamin D receptor (VDR), a steroid family receptor and modulates various downstream pathways. Multiple polymorphisms have been determined in VDR gene that witnessed significant association with cancer development and progression. Therefore, in this maiden study, we recruited 75 newly diagnosed MM patients and 75 control subjects. 25-hydroxy vitamin D (25(OH)D) levels were measured in all recruited study subjects. Further, PCR-RFLP was performed in DNA samples of recruited study subjects. Results demonstrated significantly decreased 25(OH)D levels in MM patients compared to controls. Additionally, decreased 25(OH)D levels in MM patients inversely associated with disease severity. Further, single nucleotide polymorphism (SNP) analysis of VDR gene showed significantly higher risk of MM disease development in Ff+ ff, Aa+ aa, and Bb+ bb genotypes. Additionally, FokI f, ApaI a and BsmI b alleles were significantly associated with MM occurrence. In conclusion, this study provided initial evidences of association between 25(OH)D insufficiency, VDR gene polymorphism and MM development. Thus, we suggest that a study involving assessment of 25(OH)D levels and VDR gene polymorphism in large patients' cohort might substantiate their role in MM development which would further provide impetus to give 25(OH)D supplementation along with conventional chemotherapeutic agents for myeloma treatment in future.

In this review, we discuss the sources, formation, metabolism, function, biological activity, and potency of C3-epimers (epimers of vitamin D). We also determine the role of epimerase in vitamin D-binding protein (DBP) and vitamin D receptors (VDR) according to different subcellular localizations. The importance of C3 epimerization and the metabolic pathway of vitamin D at the hydroxyl group have recently been recognized. Here, the hydroxyl group at the C3 position is orientated differently from the alpha to beta orientation in space. However, the details of this epimerization pathway are not yet clearly understood. Even the gene encoding for the enzyme involved in epimerization has not yet been identified. Many published research articles have illustrated the biological activity of C3 epimeric metabolites using an in vitro model, but the studies on in vivo models are substantially inadequate. The metabolic stability of 3-epi-1α,25(OH)2D3 has been demonstrated to be higher than its primary metabolites. 3-epi-1 alpha, 25 dihydroxyvitamin D3 (3-epi-1α,25(OH)2D3) is thought to have fewer calcemic effects than non-epimeric forms of vitamin D. Some researchers have observed a larger proportion of total vitamin D as C3-epimers in infants than in adults. Insufficient levels of vitamin D were found in mothers and their newborns when the epimers were not included in the measurement of vitamin D. Oral supplementation of vitamin D has also been found to potentially cause increased production of epimers in mice but not humans. Moreover, routine vitamin D blood tests for healthy adults will not be significantly affected by epimeric interference using LC-MS/MS assays. Recent genetic models also show that the genetic determinants and the potential factors of C3-epimers differ from those of non-C3-epimers.Most commercial immunoassays techniques can lead to inaccurate vitamin D results due to epimeric interference, especially in infants and pregnant women. It is also known that the LC-MS/MS technique can chromatographically separate epimeric and isobaric interference and detect vitamin D metabolites sensitively and accurately. Unfortunately, many labs around the world do not take into account the interference caused by epimers. In this review, various methods and techniques for the analysis of C3-epimers are also discussed. The authors believe that C3-epimers may have an important role to play in clinical research, and further research is warranted.

India is a densely populated country known for its traditional, cultural and lingual diversity. In India Deficiency of vitamin D is seen in both the genders and among all the age groups. Micronutrient deficiencies are steadily adding to the increasing burden of health related co-morbidities with low dietary calcium and magnesium intake in Indian population. Despite lots of sunshine, vitamin D insufficiency is widespread in India according to the age and regions (50-90%). In order to increase vitamin D intake with normal diet, the food industry will have to find a more effective strategy to improve general health conditions. The breadth of widely used foods, including milk, cheese, margarine, dairy products, and various breakfast drinks, can improve the condition of vitamin D deficiency in Asian countries such as India. The requirements for calculating the necessary micronutrients and vitamin D fortification of foods and drinks, successful strategies should be developed and emphasized. There is need to improve the effectiveness of various fruit drinks through fortification of vitamin D, which can reduce vitamin D deficiency in the general population as well as in different age groups.

Myasthenia gravis (MG) is an autoimmune disorder, most often caused by pathogenic autoantibodies (Abs) against the nicotinic acetylcholine receptor (nAChR) at the neuromuscular junction (NMJ).1 The clinical syndrome was first described by a woman initially thought to be suffering from hysteria presenting with generalized weakness, squint and dysphagia by Samuel Wilks in 1877.2 The incidence and prevalence of MG have increased over time, but this disease is still relatively rare. Globally, the prevalence of MG in most populations studied is between 100 and 200 per million,3 while the reported incidence varies widely between 1.7 and 10.4 per million.1 MG affects both sexes at all ages but is prevalent mostly in women during early adulthood (age <40 years). During puberty and older age, the incidence has been reported to be equal,4 but there are reports of higher incidence in men above the age of 50.5,6 There is evidence of MG being underdiagnosed in old age (>80 years). This has been attributed to variability in diagnoses in this age group, as symptoms are often interpreted as stroke or motor neuron disease.6

Vitamin D deficiency is common and associated with mortality in chronic kidney disease (CKD) patients. Cardiovascular disease (CVD) is the commonest cause of mortality in CKD patients. In a randomized, double blind, placebo controlled trial, we have recently reported favorable effects of vitamin D supplementation on vascular & endothelial function and inflammatory biomarkers in vitamin D deficient patients with non-diabetic stage 3–4 CKD (J Am Soc Nephrol 28: 3100–3108, 2017). Subjects in the placebo group who had still not received vitamin D after completion of the trial received two oral doses 300,000 IU of oral cholecalciferol at 8 weeks interval followed by flow mediated dilatation (FMD), pulse wave velocity (PWV), circulating endothelial and inflammatory markers (E-Selectin, vWF, hsCRP and IL-6), 125 (OH)2D, iPTH and iFGF-23 assessment at 16 weeks. 31 subjects completed this phase of the study. Last values recorded in the preceding clinical trial were taken as baseline values. Serum 25(OH)D and 1,25(OH)2D increased and FMD significantly improved after cholecalciferol supplementation [mean change in FMD%: 5.8% (95% CI: 4.0–7.5%, p < 0.001]. Endothelium independent nitroglycerine mediated dilatation, PWV, iPTH, iFGF-23 and IL-6 also showed favorable changes. The data further cement the findings of beneficial effects of correction of vitamin D deficiency on vascular function.

The determination of free 25-hydroxyvitamin D (25(OH)D) as compared to the analysis of total 25-hydroxyvitamin D might reflect better the vitamin D status during pregnancy, since vitamin D-binding protein (DBP) concentrations increase throughout pregnancy and the vast majority of 25(OH)D is tightly bound to DBP thus strongly influencing total 25(OH)D. The concentration of the biologically active free 25(OH)D - on the other hand - is much less dependent on the DBP concentrations. The study was conducted in May-June 2016 in 368 Caucasian pregnant healthy women - residents of Northeastern Germany. Free 25(OH)D was either measured directly by commercial ELISA kit or assessed by calculation via total 25(OH)D, DBP, and albumin serum concentrations. Regardless of the detection method, free 25(OH)D lowers in the 3rd trimester comparing to the 1st trimester (by 12% and 21%, p < 0.05 and p < 0.001, for measured and calculated free 25(OH)D, respectively), whereas total 25(OH)D was not decreased in late pregnancy. DBP rises with gestational age. Total 25(OH)D was not correlated with serum calcium (p = 0.251), whereas free 25(OH)D was significantly (p = 0.007 for measured free 25(OH)D and p < 0.001 for calculated free 25(OH)D) positively correlated with calcium. All 25(OH) D isoforms were significantly negatively correlated with bone-specific alkaline phosphatase (BSAP), however the correlation strength was the lowest with total 25(OH)D (rho = -0.108, p = 0.038), whereas both measured and calculated free 25(OH)D revealed better associations with BSAP (rho = -0.203 and rho = -0.211 for measured and calculated free 25(OH)D, respectively, p < 0.001 for both). We established pregnancy trimester specific reference intervals for free measured and calculated 25(OH)D and DBP. Both measured and calculated free 25(OH)D showed better correlations with parameters of the endocrine vitamin D system (calcium and BSAP). Both ways of measuring free 25(OH)D in pregnant women are suitable as novel laboratory parameter for vitamin D status monitoring during human pregnancy and might replace in the future the routine total 25(OH)D assessment.

Normal humans of all ages have the innate ability to produce vitamin D following sunlight exposure. Inadequate vitamin D status has shown to be associated with a wide variety of diseases, including oral health disorders. Insufficient sunlight exposure may accelerate some of these diseases, possibly due to impaired vitamin D synthesis. The beneficial effects of vitamin D on oral health are not only limited to the direct effects on the tooth mineralization, but are also exerted through the anti-inflammatory functions and the ability to stimulate the production of anti-microbial peptides. In this article, we will briefly discuss the genesis of various oral diseases due to inadequate vitamin D level in the body and elucidate the potential benefits of safe sunlight exposure for the maintenance of oral and general health.