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GENERAL COMMENTARY article

Front. Psychiatry, 28 October 2022
Sec. Molecular Psychiatry
Volume 13 - 2022 | https://doi.org/10.3389/fpsyt.2022.971412
This article is part of the Research Topic Post-Operative Neuropsychiatric Disorder View all 15 articles

Commentary: Correlation analysis of serum vitamin D levels and post-operative cognitive disorder in elderly patients with gastrointestinal tumor

This article is a commentary on:

  1. Correlation Analysis of Serum Vitamin D Levels and Postoperative Cognitive Disorder in Elderly Patients With Gastrointestinal Tumor

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\nNikhil Ravindranath Tondehal Nikhil Ravindranath Tondehal1*Saadiya HawaSaadiya Hawa2Anem Sajid MalikAnem Sajid Malik3Kazi Nadia HamidKazi Nadia Hamid4Ashley MalekunnelAshley Malekunnel5Mahwish Adnan&#x;Mahwish Adnan6†Chintan Trivedi&#x;Chintan Trivedi6†Zeeshan Mansuri&#x;Zeeshan Mansuri7†Shailesh Jain&#x;Shailesh Jain6†
  • 1Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, United States
  • 2Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, United States
  • 3King Edward Medical University, Lahore, Pakistan
  • 4Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
  • 5Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • 6Department of Psychiatry, Texas Tech University of Health Sciences, Midland, TX, United States
  • 7Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States

A Commentary on
Correlation analysis of serum vitamin D levels and postoperative cognitive disorder in elderly patients with gastrointestinal tumor

Zhang, J., Zhang, X., Yang, Y., Zhao. J., and Yu, Y. Front Psychiatry. (2022) 13:893309. doi: 10.3389/fpsyt.2022.893309

Dear Editor,

We read with great interest the article, ‘Correlation Analysis of Serum Vitamin D Levels and Post-operative Cognitive Disorder (POCD) in Elderly Patients With Gastrointestinal Tumor' (1). This relevant article has explored the ongoing discussion regarding Vitamin D's multiple roles in maintaining health.

We have the following additional thoughts. The study missed addressing the complications faced during recovery from the surgery. Examples that can influence cognition are anesthesia recovery and electrolyte imbalance because of fluid loss during or after the surgery. Also, body weight plays a role in anesthesia recovery, i.e., lipid-soluble anesthetics with redistribution may affect a smooth recovery and result in continued confusion (2). The study failed to consider the association between the different anesthesia depths and POCD (3). The study misses considering the role of post-operative pain management in altering cognition (4). Elderly patients with gastrointestinal tumors may have fat depletion, influencing the absorption of fat-soluble vitamins such as Vitamins A, D, E, and K (5). Nutrient absorption is affected in most gastrointestinal tumors, especially fat absorption (6). Vitamins D, A, and K have antioxidant properties that influence post-surgery recovery (7, 8). Therefore, one way to identify absorption abnormalities could be to check the levels of other fat-soluble vitamins (A, E, and K). These findings suggest that low Vitamin D levels could be an expected and coincidental finding (9).

As Major Depressive Disorder affects cognition, screening patients for pre-existing depression could have been informative (10). The study discusses different confounders and mentions age and sex as significant confounders. However, the article does not clarify whether the odds ratios presented are crude or adjusted using multivariate logistic regression. In addition, women are more prone to osteoporosis and low vitamin D levels after menopause (11). It would be helpful to know the extent of confounding by reviewing the crude and adjusted odds ratios. Controlling for factors mentioned above (depression, anesthesia recovery, and pain management) would help provide a robust result that would assist the clinicians.

We believe that addressing the above issues will further improve the impact of this study.

Author contributions

NT, SH, and ASM wrote the initial manuscript. AM and KH searched relevant literature and added references. NT, MA, CT, ZM, and SJ further proofread and edited the manuscript. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Zhang J, Zhang X, Yang Y, Zhao J, Yu Y. Correlation analysis of serum vitamin D levels and postoperative cognitive disorder in elderly patients with gastrointestinal tumor. Front Psychiatry. (2022) 13:893309. doi: 10.3389/fpsyt.2022.893309

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Xie S, Xie M. Effect of dexmedetomidine on postoperative delirium in elderly patients undergoing hip fracture surgery. Pak J Pharm Sci. (2018) 31:2277–81.

PubMed Abstract | Google Scholar

3. Shu AH, Wang Q, Chen XB. Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial. Curr Med Res Opin. (2015) 31:1883–7. doi: 10.1185/03007995.2015.1075968

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Wang Y, Sands LP, Vaurio L, Mullen EA, Leung JM. The effects of postoperative pain and its management on postoperative cognitive dysfunction. Am J Geriatr Psychiatry. (2007) 15:50–9. doi: 10.1097/01.JGP.0000229792.31009.da

PubMed Abstract | CrossRef Full Text | Google Scholar

5. Rino Y, Oshima T, Yoshikawa T. Changes in fat-soluble vitamin levels after gastrectomy for gastric cancer. Surg Today. (2017) 47:145–50. doi: 10.1007/s00595-016-1341-5

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Montoro-Huguet MA, Belloc B, Domínguez-Cajal M. Small and large intestine (I): malabsorption of nutrients. Nutrients. (2021) 13:1254. doi: 10.3390/nu13041254

PubMed Abstract | CrossRef Full Text | Google Scholar

7. National Research Council (US) Committee on Diet and Health. Diet and Health: Implications for Reducing Chronic Disease Risk. Fat-Soluble Vitamins. Washington, DC: National Academies Press (US) (1989). p. 11. Available online at: https://www.ncbi.nlm.nih.gov/books/NBK218749/ (accessed June 17, 2022).

Google Scholar

8. Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. (2010) 89:219–29. doi: 10.1177/0022034509359125

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Javorsky BR, Maybee N, Padia SH, Dalkin AC. Vitamin D deficiency in gastrointestinal disease. Pract Gastroenterol. (2006) 30:52–72.

PubMed Abstract | Google Scholar

10. Morimoto SS, Kanellopoulos D, Alexopoulos GS. Cognitive impairment in depressed older adults: implications for prognosis and treatment. Psychiatr Ann. (2014) 44:138–42. doi: 10.3928/00485713-20140306-05

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Narula R, Tauseef M, Ahmad IA, Agarwal K, Ashok A, Anjana A. Vitamin d deficiency among postmenopausal women with osteoporosis. J Clin Diagn Res. (2013) 7:336–8. doi: 10.7860/JCDR/2013/5022.2761

PubMed Abstract | CrossRef Full Text | Google Scholar

Keywords: POCD, gastrointestinal surgery, abdominal surgery, vitamin D level deficiency, cognitive change

Citation: Tondehal NR, Hawa S, Malik AS, Hamid KN, Malekunnel A, Adnan M, Trivedi C, Mansuri Z and Jain S (2022) Commentary: Correlation analysis of serum vitamin D levels and post-operative cognitive disorder in elderly patients with gastrointestinal tumor. Front. Psychiatry 13:971412. doi: 10.3389/fpsyt.2022.971412

Received: 23 June 2022; Accepted: 05 October 2022;
Published: 28 October 2022.

Edited by:

Attila Szabo, University of Oslo, Norway

Reviewed by:

Manu Suresh Sharma, Yale University, United States

Copyright © 2022 Tondehal, Hawa, Malik, Hamid, Malekunnel, Adnan, Trivedi, Mansuri and Jain. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Nikhil Ravindranath Tondehal, ZHJuaWsudG9uZGVoYWwmI3gwMDA0MDtnbWFpbC5jb20=

†These authors have contributed equally to this work and share last authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.