1. Current Vitamin D Recommendations Merely a Fraction of Safe and Perhaps Essential Levels for Children
2. Hormone May Hold Key to Helping Elderly Men Live Longer
3. New Insights in Diagnosing Diabetes May Help the Millions Who are Undiagnosed
4. ENDO 08 Preliminary News Conference and Webcast Schedule
5. New Hormone Foundation Patient Guide to Diagnosing Cushing’s Syndrome

1. Current Vitamin D Recommendations Merely a Fraction of Safe and Perhaps Essential Levels for Children

The current recommended daily allowance (RDA) of vitamin D for children is 200 International Units (IUs), but new research reveals that children may need and can safely take ten-times that amount. According to a recently accepted report in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), this order-of-magnitude increase could improve the bone health of children worldwide and may have other long-term health benefits.

“Our research reveals that vitamin D, at doses equivalent to 2,000 IUs a day, is not only safe for adolescents, but it is actually necessary for achieving desirable vitamin D levels,” said Ghada El-Haff Fuleihan, M.D., of the American University of Beirut-Medical Center, Lebanon, and lead author of the study.

Vitamin D is an essential hormone for bone growth and development in children and promotes skeletal health in adults. Currently, the National Academy of Sciences’ Institute of Medicine recommends an adequate daily intake of 200 IUs of vitamin D for children. This is also the recommendation from the American Academy of Pediatrics. These levels, however, may not be adequate for bone growth and musculoskeletal health in children and adolescents.

“Data on appropriate vitamin D levels in the pediatric age group are lacking,” said Dr. Fuleihan. “This is a major obstacle to finding the right daily allowance to enhance musculoskeletal health.”

To help clarify these important guidelines, Fuleihan and his colleagues conducted both short- and long-term trials to gauge the safety of relatively high doses of vitamin D3 in children ages 10-17 years.

Vitamin D3 is one of the most common forms of vitamin D, and is easily converted to 25-OHD (25-hydroxyvitamin), which is the active form of vitamin D found in the blood.

For this placebo-controlled study, researchers gave children various doses of vitamin D at various intervals and measured the impact this had on serum levels of 25-OHD.

For the short-term study, 25 students (15 boys and 10 girls) received one-weekly, 14,000 IU doses of vitamin D for eight weeks. Serum levels of 25-OHD were then measured for an additional eight weeks. This portion of the test was conducted during the summer and early fall, when the highest natural levels of vitamin D are reached.

For the long-term, one-year study, 340 students (172 boys and 168 girls) received either a low dose of vitamin D (1,400 IUs each week) or a high dose (14,000 IUs each week).

Only children given the equivalent of 2,000 IUs a day of vitamin D increased 25-OHD levels from the mid-teens to the mid-thirties (ng/ml)—the level considered optimal for adults. None of the children in either trial showed any evidence for vitamin D intoxication.

Although many experts agree that a 25-OHD level of 30 ng/ml is desirable in adults, what constitutes an optimal D level for children and adolescents is more debatable. According to the researchers, due to rapid skeletal growth, children and adolescents are more likely to be vitamin D deficient, and are far less likely to reach vitamin D levels that doctors would consider toxic.

“Supplementation of children and adolescents with 2,000 IUs a day of vitamin D3 is well tolerated and safe,” said Dr. Fuleihan. “This is particularly relevant in light of the increasingly recognized health benefits of vitamin D for adults and children.”

Other researchers involved in the study include Joyce Maalouf, Mona Nabulsi, Reinhold Vieth, Samantha Kimball, Rola El-Rassi, and Ziyad Mahfoud.

The study “Short term and long term safety of weekly high dose vitamin D3 supplemetnation in school children” will be published in the July issue of JCEM.

2. Hormone May Hold Key to Helping Elderly Men Live Longer

Elderly men with higher activity of the hormone IGF-1—or insulin-growth factor 1—appear to have greater life expectancy and reduced cardiovascular risk, according to a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM).

IGF-1 is a hormone similar in molecular structure to insulin. It is released from the liver and plays an important role in childhood growth and continues to have anabolic effects in adults.

In this study, researchers evaluated 376 healthy elderly men between the ages of 73 and 94 years. A serum sample was taken from each subject at the beginning of the study and researchers were contacted about the status of the participants over a period of eight years.

Subjects with the lowest IGF-1 function had a significantly higher mortality rate than subjects with the highest IGF-1 bioactivity. These results were especially significant in individuals who have a high risk to die from cardiovascular complications.

These new findings come as a result of a new form of testing for IGF-bioactivity. Researchers in this study used a new method, a bioassay, to measure the function of IGF-1 in the blood. Compared to commonly used methods to measure IGF-1, the IGF-1 bioassay gives more information about the actual function (bioactivity) of circulating IGF-1 in the body.

“The bioassay allowed us to more clearly see the association between high circulating IGF-1 bioactivity and extended survival,” said Michael Brugts, MD, of the Erasmus Medical Center in Rotterdam, The Netherlands and lead author of the study. “Interestingly, we could not find such a relationship when IGF-1 in blood was measured with the more commonly used methods.”

Immunoassays, commonly used previously to determine IGF-1 circulation levels, remove certain proteins that interfere with accurate measurements. Recent studies however have found that these proteins are important modulators of IGF-1 bioactivity. The bioassay used in this study does not disregard or remove this protein, thus enabling researchers to have a more accurate understanding of IGF-1 function.

Determination of IGF-1 function using the bioassay opens the possibility to gather new insights about the functions of IGF-1 in the body, said Brugts.

Other researchers working on the study include A.W. Van den Beld, L.J. Hofland, K. van der Wansem, P.M. van Koetsveld, S.W.J. Lamberts, and J.A.M.J.L. Janssen of Erasmus Medical Center in Rotterdam, The Netherlands and J. Frystyk of Aarhus University Hospital in Aarhus, Denmark.

The article “Low Circulating IGF-1 Bioactivity in Elderly Men is Associated with Increased Mortality,” will appear in the June issue of JCEM, a publication of The Endocrine Society.

3. New Insights in Diagnosing Diabetes May Help the Millions Who are Undiagnosed

In light of the 6.2 million Americans who don’t realize they have diabetes, a panel of experts examined the current criteria for screening and diagnosing the disease and found a significant need for improvement. Their conclusions and recommendations can be found in a new report accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM).

“Approximately 30 percent of people with diabetes in the United States are undiagnosed,” said Christopher Saudek, M.D., of Johns Hopkins School of Medicine in Baltimore, Md., and lead author of the report. “There are serious deficiencies in the current criteria for diagnosing diabetes and these shortcomings are contributing to avoidable morbidity and mortality”.

One reason so many people with diabetes are undiagnosed is because commonly prescribed diagnostic tests require that a patient be fasting, said Saudek. This means that people who have eaten on the day of a doctor visit will not be diagnosed unless they have quite advanced diabetes.

As an alternative to the fasting plasma glucose or oral glucose tolerance tests, the panel suggested incorporating another measurement of glucose, hemoglobin A1c (HbA1c), into criteria for screening and diagnosing diabetes.

Hemoglobin is the oxygen-carrying protein located in red blood cells. HbA1c is a form of hemoglobin that reflects the average blood glucose level over the previous several months, and has been used for a long time to indicate blood sugar levels in patients with diabetes. But it has never been officially accepted as a way for doctors to screen for or diagnose diabetes.

Current recommendations of the American Diabetes Association were made a decade ago and they rejected the use of HbA1c as a diagnostic tool largely because it was considered at the time to be inadequately standardized and insensitive. Given more recent evidence, the panel believes it is time to revisit using HbA1c and include it as necessary criteria in screening and diagnosing diabetes.

The measurement of HbA1c does not require fasting, while current accepted tests require the patient to fast for at least eight hours. Furthermore, HbA1c more accurately reflects longer-term glucose concentration in the blood; other tests can easily be affected by short-term lifestyle changes, such as a few days of dieting or exercise. And finally, HbA1c laboratory methods are now well standardized and reliable.

The panel recommends that screening standards be established that prompt further testing and closer follow-up. Standards could include HbA1c tests, for example HbA1c greater than 6 percent would qualify as being in need of follow-up; HbA1c greater than or equal to 6.5 percent confirmed by a glucose-dependent test should establish the diagnosis of diabetes.

Other members of the panel include William Herman of the University of Michigan in Ann Arbor, Mich.; David Sacks of Harvard Medical School in Boston, Mass.; Richard Bergenstal of the International Diabetes Center in Minneapolis, Minn.; David Edelman of Duke University in Durham, N.C.; and Mayer Davidson of Charles R. Drew University in Los Angeles, Calif.

The article “A New Look at Screening and Diagnosing Diabetes Mellitus,” will appear in the July issue of JCEM, a publication of The Endocrine Society.

4. ENDO 08 Preliminary News Conference and Webcast Schedule

Breaking news on sexual performance, diabetes, combating obesity, steroid abuse and growth hormone doping will be presented in a series of news briefings at ENDO 08, the 90th annual meeting of The Endocrine Society. ENDO 08 will take place on June 15-18 at the Mocone Center in San Francisco, California.

Sunday, June 15

Sexy Sex Findings (8:30 a.m. PDT): Breaking news on sexual performance for men and women. Topics include erectile dysfunction, boosting women’s libido, and fertility and obesity.

Diabetes Discoveries (10:30 a.m. PDT): Latest discoveries on the cardiovascular and prenatal impact of diabetes and possible role of fitness in treatment.

Monday, June 16

Breakthroughs in Combating Obesity (8:30 a.m. PDT): New ways of controlling appetite and combating obesity.

Frontier Research and Exciting Results (10 a.m. PDT): Latest discoveries on estrogen and breast cancer, bone health, and the health of companion dogs.

Tuesday, June 17

Growth Hormone Doping: New Revelations (8:30 a.m. PDT): Growth hormone doping may no longer go undetected, but does growth hormone improve athletic performance anyway?

Steroid Abuse and Clinical Use of Testosterone (9:30 a.m. PDT): Safe, therapeutic benefits of testosterone, and new Society consensus statement on steroid abuse.

Weight-loss Surgery: Benefits are More than Skin Deep (12:30 p.m.): Bariatric and Lap-Band surgery show more health benefits than treating obesity.

* Dates and times may change. A final news conference schedule will be issued before the meeting. Reporters may register for the meeting here: http://www.endo-society.org/endo/media.cfm

Reporters may also register for live news conference webcasts on: http://www.endowebcasting.com

The News Room (Moscone Center, Rooms 232-234) will include reporters' mailboxes, work space, and an Internet hub. The News Conference Room (Moscone Center, Room 230) will be the site of all briefings.

5. New Hormone Foundation Patient Guide to Diagnosing Cushing’s Syndrome

In conjunction with The Endocrine Society, The Hormone Foundation has published the "Patient Guide to Diagnosing Cushing’s Syndrome." This publication is based on the clinical guidelines of The Endocrine Society. It summarizes who should be tested for Cushing’s Syndrome, what the recommended diagnostic tests are and how to prepare for them, and what a patient can do to help in the diagnostic process. To download free copies and other useful health resources for patients, visit the Foundation's Web site (www.hormone.org).

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Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.