The unprecedented events of 2020 have set the stage for a unique year in health care. Clinicians have faced enormous challenges in providing care in the face of limited resources and information. In times when we are faced with making difficult clinical decisions, the value of data and peer review has never been more evident and vital in guiding our practice.

This issue presents a compilation of research and reviews related to vitamin D. Several articles focus on the relationship of vitamin D in certain disease states and how to assess vitamin D in various populations.

Drummond and Kraft studied undergraduate students using a 3-day food record to estimate median daily average vitamin D intake through nutrient analyses and correlated it with a vitamin D checklist. The checklist, which included groupings of high vitamin D foods, was used to examine the relationship of certain foods to the percentage of vitamin D recommended dietary allowance (RDA) met. Average vitamin D intake correlated with higher vitamin D checklist recall of milk, vitamin D fortified cereal, and American cheese consumption. The vitamin D checklist may allow for an easy-to-use assessment of vitamin D intake for determination of the need for biochemical evaluation or supplementation of vitamin D.

Heitman, Nahikian-Nelms, and Roberts of Ohio State University looked at vitamin D and calcium intake in an outpatient gastroenterology (GI)/hepatology clinic to assess dietary patterns and metabolic bone disease (MBD) risk. A food frequency questionnaire was offered to patients, and an average healthy eating score and calcium and vitamin D levels were determined. While average dietary calcium intake was 100% of the RDA, 16% of participants consumed less than 50% of the RDA. Average vitamin D intake was found to be only 57% of the RDA. Because of the concern of nutrient deficiency contributing to MBD risk, assessment of dietary intake and absorptive ability of calcium and vitamin D is highlighted as a critical function of the registered dietitian nutritionist (RDN) in the outpatient GI/hepatology population.

Researchers at Rutgers University have provided 2 narrative reviews related to vitamin D. Gomes, Parker, and Zelig evaluated the relationship of vitamin D status to pulmonary function in children with cystic fibrosis. The review of 4 articles varied in their findings. Two studies identified higher vitamin D levels associated with better pulmonary function in certain subgroups, one found an increase in pulmonary exacerbations associated with lower vitamin D levels, and another study found no association. The lack of consistent findings points to the need of a larger, multicenter study to further elucidate this relationship.

Johnson, Zelig, and Parker examined the relationship between vitamin D status and attention-deficit/hyperactivity disorder (ADHD) in children through a review of the literature. Their findings suggest that while children with ADHD are more likely to have lower levels of vitamin D than children without ADHD, the relationship between vitamin D levels and ADHD risk cannot be clearly established. Identifying vitamin D deficiency in this high-risk population remains important, and further study of the role of vitamin D supplementation in children with ADHD is warranted.

Kazemi, Hezaveh, Nikniaz, and Nikniaz of Tabriz University of Medical Science in Iran evaluated the association of household food insecurity (HFI) and iron deficiency, iron deficiency anemia, and vitamin D deficiency in 266 women of reproductive age in East Azerbaijan, Iran. Their findings revealed a significant positive association between HFI and anemia, but no association between HFI and iron deficiency or HFI and vitamin D deficiency (defined as serum 25-hydroxy vitamin D levels less than 30 nmol/L). Although these correlations do not imply causation, HFI may play a role in dietary choices and micronutrient consumption in this high-risk population. It is important to note that the prevalence of both iron deficiency and vitamin D deficiency in this population is high at baseline.

With a focus on vitamin D, it is important to consider the field of dietary supplements. O'Dwyer and Vegiraju provide a comprehensive overview of the regulation and safety of dietary supplements. This review highlights the process of supplement regulation by the Food and Drug Administration, including an overview of claims, labeling, advertising, and packaging. A discussion of safety processes and resources provides a useful guide for clinicians when addressing dietary supplements.

Koczarski of Central Michigan University completed a review of 8 randomized controlled trials examining the effect of probiotics on glycemic control in women with gestational diabetes mellitus (GDM). Although it is unclear how probiotics may influence glycemic control in this population, significant findings included an association between probiotics and decreased fasting plasma glucose, decreased serum insulin levels, and improved lipid profiles. The limitations of the trials included short duration, small samples sizes, and variable strains of probiotics used. More rigorous trials are needed to further clarify the impact of probiotics in women with GDM.

Wright and Epps designed, pilot tested, and validated the Rapid Nutrition Screening for HIV disease in order to address the absence of such a validated tool in this population. The 7-question tool screens for food security as well as for common nutrition complications in people living with HIV/AIDS. Validation, which involved assessment of nutrition risk by case managers and RDNs, revealed a high degree of agreement between the 2 groups. The tool, which was valid across gender and cultural groups, can be used to standardize nutrition screening in this population.

Arts et al evaluated the research skills of students enrolled in a 100% online, nonthesis master's dietetics program after completion of a 4-course research curriculum to determine whether the curriculum improved students' research skills or increased students' interest in conducting research. Skills were evaluated using a 22-question survey and revealed a significant self-reported improvement in 8 of 11 research skills. There was a nonsignificant decreased interest in several research skills, although the interest of the students was noted to be fairly high at baseline. This study demonstrates that the use of a research curriculum may facilitate improved perception of research skills. Further study is needed to determine whether this translates to greater involvement in research postgraduation.

Thank you for your support of Topics in Clinical Nutrition. We would like to welcome the new members of our editorial board: Rebecca Couris, Carol Ireton-Jones, Laura Feldman, Mary Marion, and Kathy Prelack. We are honored to have you share your expertise and continue to advance the profession of nutrition and dietetics.

-Kelly Kane, MS, RD, CNSC

Editor

Topics in Clinical Nutrition