820
lacking. Moreover we do not know if the trends found in large populations (i.e., the variability of H.D.L.;,, but not H.D.L.3 and the H.D.L.z-V.L.D.L. interrelationships) are reflected in temporal changes in lipoprotein patterns of individuals with C.H.D. The Modesto results accentuate the need for delineating the metabolic basis of H.D.L.-V.L.D.L. interrelationships in the context of possible primaryl4 or secondaryl5 risk-factor status are
for total
H.D.L.
have been described with plasma-25-OHD levels of up to 8 ng/ml, a value approximating to that found in healthy persons.’ Our findings showing an absence of osteomalacia in the presence of plasma-25-OHD levels normally associated with vitamin-D deficiency osteomalacia suggest that care should be taken in. interpreting the low plasma-25-OHD concentrations.
Dunn Nutritional
Molecular Disease Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20014, U.S.A.
Laboratory,
R. T. JUNG
Cambridge D. W. ANDERSON
LOW PLASMA-25-HYDROXYVITAMIN D WITHOUT OSTEOMALACIA
StR,—The general availability of assays for 25-hydroxyvitain plasma has led to several population surLow plasma-25-OHD levels have been found in some groups, and it has been suggested that this measurement reflects vitamin-D status and that a low value is associated with subclinical vitamin-D deficiency.l,5 We have seen patients with very low plasma-25-OHD values whose serum calcium and phosphate levels or bone histology have led us to doubt the presence of osteomalacia. The accompanying table gives details of seven such patients tested between January and November, 1977. Bone pain was present in cases 6 and 7, and case 7 had a proximal myopathy. Only in case 6 did bone biopsy show osteomalacia, and Looser’s zones were seen only in case 7. In cases 6 and 7 the osteomalacia was healed by ultraviolet min D
M. DAVIE D. E. M. LAWSON
cholesterol.
(25-OHD)
veys.l-4
BLOOD-SUGAR AND PROGNOSIS OF MYOCARDIAL INFARCTION
SiR,—The measurement of blood-sugar may be useful to determine the outcome of myocardial infarction,l an appealing idea because of the uncertain role that hospital treatment plays in the survival of the low-risk case.2
light. Normal values for plasma-25-OHD in this laboratory (meanis.D. in ng/ml) are: males under 45 (December to March) 9-8±3-8, females under 30 (December to March) 10-7±1-8; males over 65 (July) 10-1±5-9; females over 65 (July) 8.Oil.7. Thus all seven patients had 25-OHD values considerably below normal. Yet osteomalacia was diagnosed in only two of them. Similar low levels have been found amongst persons over 65 in a nutritional survey6 and in an Asian community on Stornoway.’ Both groups were apparently healthy and not investigated in detail. Conversely patients with vitamin-D-deficiency osteomalacia Miller, G. J., Miller, N. E. Lancet, 1975, i, 16. Cramp, D. G., Tickner, T. R. ibid. 1977, ii, 1086. Preece, M. A., Tomlinson, S., Ribot, C. A., Pietrek, J., Korn, H. T., Davies, D. M., Ford, J. A., Dunnigan, M. G., O’Riordan, J. L. H. Q. Jl. Med. 1975, 44, 575. 2. Corless, D., Beer, M., Boucher, B. J., Gupta, S. P., Cohen, R. D. Lancet, 1975, i, 1404. 3. Stamp, T. C. B., Round, J. M., Rowe, D. J. F., Haddad, J. G., Br. med. J. 1972, iv, 9. 4. Long, R. G., Skinner, R. K., Wills, M. R., Sherlock, S., Lancet, 1976, ii,
14. 15. 1.
650.
Edelstein, S., Charman, M., Lawson, D. E. M., Kodicek, E. Clin. Sci. mol. Med. 1975, 46, 231. 6. Lawson, D. E. M. Unpublished. 5.
PATIENTS WITH LOW
I
I
I
I
I
The blood-sugar (whole venous blood, glucose oxidase) was measured in all patients on admission to the coronary-care unit (c.c.u.) at this hospital from June to November, 1977. There were 166 with definite infarction of less than 24 h duration 7. Mawer, E. B., Backhouse, J., Hill, L. F., Lumb, G. A., de Silva, P., C. M., Stanbury, S. W. Clin. Sci. mol. Med. 1975, 48, 349. 1. Modan, B., Schar, S., Shan, M. J. Am. med. Ass. 1975, 233,266. 2. Mather, H. G., and others Br. med. J. 1971, iii, 334.
PLASMA-25-0HD VALUES
I
I
t Normal ranges: calcium 2.0-2.6mmol/l, phosphate O. 8-1.4 mmol/l, alkaline phosphatase 30-92 I.v./l.
I
Taylor,
lacking. Moreover we do not know if the trends found in large populations (i.e., the variability of H.D.L.;,, but not H.D.L.3 and the H.D.L.z-V.L.D.L. interrelationships) are reflected in temporal changes in lipoprotein patterns of individuals with C.H.D. The Modesto results accentuate the need for delineating the metabolic basis of H.D.L.-V.L.D.L. interrelationships in the context of possible primaryl4 or secondaryl5 risk-factor status are
for total
H.D.L.
have been described with plasma-25-OHD levels of up to 8 ng/ml, a value approximating to that found in healthy persons.’ Our findings showing an absence of osteomalacia in the presence of plasma-25-OHD levels normally associated with vitamin-D deficiency osteomalacia suggest that care should be taken in. interpreting the low plasma-25-OHD concentrations.
Dunn Nutritional
Molecular Disease Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20014, U.S.A.
Laboratory,
R. T. JUNG
Cambridge D. W. ANDERSON
LOW PLASMA-25-HYDROXYVITAMIN D WITHOUT OSTEOMALACIA
StR,—The general availability of assays for 25-hydroxyvitain plasma has led to several population surLow plasma-25-OHD levels have been found in some groups, and it has been suggested that this measurement reflects vitamin-D status and that a low value is associated with subclinical vitamin-D deficiency.l,5 We have seen patients with very low plasma-25-OHD values whose serum calcium and phosphate levels or bone histology have led us to doubt the presence of osteomalacia. The accompanying table gives details of seven such patients tested between January and November, 1977. Bone pain was present in cases 6 and 7, and case 7 had a proximal myopathy. Only in case 6 did bone biopsy show osteomalacia, and Looser’s zones were seen only in case 7. In cases 6 and 7 the osteomalacia was healed by ultraviolet min D
M. DAVIE D. E. M. LAWSON
cholesterol.
(25-OHD)
veys.l-4
BLOOD-SUGAR AND PROGNOSIS OF MYOCARDIAL INFARCTION
SiR,—The measurement of blood-sugar may be useful to determine the outcome of myocardial infarction,l an appealing idea because of the uncertain role that hospital treatment plays in the survival of the low-risk case.2
light. Normal values for plasma-25-OHD in this laboratory (meanis.D. in ng/ml) are: males under 45 (December to March) 9-8±3-8, females under 30 (December to March) 10-7±1-8; males over 65 (July) 10-1±5-9; females over 65 (July) 8.Oil.7. Thus all seven patients had 25-OHD values considerably below normal. Yet osteomalacia was diagnosed in only two of them. Similar low levels have been found amongst persons over 65 in a nutritional survey6 and in an Asian community on Stornoway.’ Both groups were apparently healthy and not investigated in detail. Conversely patients with vitamin-D-deficiency osteomalacia Miller, G. J., Miller, N. E. Lancet, 1975, i, 16. Cramp, D. G., Tickner, T. R. ibid. 1977, ii, 1086. Preece, M. A., Tomlinson, S., Ribot, C. A., Pietrek, J., Korn, H. T., Davies, D. M., Ford, J. A., Dunnigan, M. G., O’Riordan, J. L. H. Q. Jl. Med. 1975, 44, 575. 2. Corless, D., Beer, M., Boucher, B. J., Gupta, S. P., Cohen, R. D. Lancet, 1975, i, 1404. 3. Stamp, T. C. B., Round, J. M., Rowe, D. J. F., Haddad, J. G., Br. med. J. 1972, iv, 9. 4. Long, R. G., Skinner, R. K., Wills, M. R., Sherlock, S., Lancet, 1976, ii,
14. 15. 1.
650.
Edelstein, S., Charman, M., Lawson, D. E. M., Kodicek, E. Clin. Sci. mol. Med. 1975, 46, 231. 6. Lawson, D. E. M. Unpublished. 5.
PATIENTS WITH LOW
I
I
I
I
I
The blood-sugar (whole venous blood, glucose oxidase) was measured in all patients on admission to the coronary-care unit (c.c.u.) at this hospital from June to November, 1977. There were 166 with definite infarction of less than 24 h duration 7. Mawer, E. B., Backhouse, J., Hill, L. F., Lumb, G. A., de Silva, P., C. M., Stanbury, S. W. Clin. Sci. mol. Med. 1975, 48, 349. 1. Modan, B., Schar, S., Shan, M. J. Am. med. Ass. 1975, 233,266. 2. Mather, H. G., and others Br. med. J. 1971, iii, 334.
PLASMA-25-0HD VALUES
I
I
t Normal ranges: calcium 2.0-2.6mmol/l, phosphate O. 8-1.4 mmol/l, alkaline phosphatase 30-92 I.v./l.
I
Taylor,
