Background: Diabetic foot ulcers (DFU) are a major complication of diabetes mellitus (DM). Nutrient deficiencies are among the major risk factors in DFU development and healing. In this context, we aimed to investigate the possible association between micronutrient status and risk of DFU.Methods: A systematic review (Prospero registration: CRD42021259817) of articles, published in PubMed, Web of Science, Scopus, CINAHL Complete, and Embase, that measured the status of micronutrients in DFU patients was performed.Results: Thirty-seven studies were considered, of which thirty were included for meta-analysis. These studies reported levels of 11 micronutrients: vitamins B9, B12, C, D, E, calcium, magnesium, iron, selenium, copper, and zinc. DFU, compared to healthy controls (HC) had significantly lower vitamin D (MD: -10.82 14 ng/ml, 95% CI: -20.47, -1.16), magnesium (MD: -0.45 mg/dL, 95% CI: -0.78, -0.12) and selenium (MD: -0.33 µmol/L, 95% CI: -0.34, -0.32) levels. DFU, compared to DM patients without DFU, had significantly lower vitamin D (MD: -5.41 ng/ml, 95% CI: -8.06, -2.76), and magnesium (MD: -0.20 mg/dL, 95% CI: -0.25, -0.15) levels. The overall analysis showed lower levels of vitamin D [15.55ng/ml (95% CI:13.44, 17.65)], vitamin C [4.99µmol/L (95% CI:3.16, 6.83)], magnesium [1.53mg/dL (95% CI:1.28, 1.78)] and selenium [0.54µmol/L (95% CI:0.45, 0.64)].Conclusion: This review provides evidence that micronutrient levels significantly differ in DFU patients, suggesting an association between micronutrient status and risk of DFU. Therefore, routine monitoring and supplementations are warranted in DFU patients. We suggest that personalized nutrition therapy may be considered in the DFU management guidelines.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259817, identifier CRD42021259817.

Introduction: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus, as it can physically and emotionally impact the person. Its management can be challenging and expensive, depending on the severity of the wound and the presence of infection. Background: The fat-soluble molecule, vitamin D, has gained great importance ever since its pleiotropism has been recognized. Its efficacy could be attributed to the presence of vitamin D receptors in most of the body tissues. Vitamin D plays a significant role in cell proliferation, differentiation, and immune modulation. It modulates the T and B cells resulting in the suppression of the immunoglobulins, autoimmunity, and inflammation. Methods: We performed a literature search with the objective to highlight the role of vitamin D in peripheral vascular disease and peripheral neuropathy, which are the major risk factors for DFU, as well as evidences of its role in wound healing and management of DFU. Results: Preclinical and clinical studies have shown that vitamin D influences multiple phases of wound healing and thereby accelerates the process. It modulates various cells involved in proliferation and remodelling phases. Vitamin D also enhances the expression of antimicrobial peptides that help to eliminate the microbes, as well as suppress the proinflammatory responses while enhancing the anti-inflammatory responses. Conclusion: This review concludes vitamin D to have a protective role in the immune and vascular system, improve glycaemic outcomes, and wound healing. Therefore, vitamin D could be a preferred adjuvant in the management of DFU.

Infections are becoming more difficult to treat, at least partly on account of microbes that produce biofilms. Reports suggest that decreased levels of antimicrobial peptides like cathelicidin, ele...

The study aimed to determine the association of vitamin D3 status with biochemical, clinical, and quality of life (QoL) in diabetic foot infection (DFI) patients. A longitudinal study was conducted in a tertiary care hospital. Baseline biochemical (glycemic, renal, plasma vitamin D3), clinical, and QoL data of the DFI patients were collected. Patients were followed up with over the telephone for four months to assess clinical outcomes (healed/not healed). A subgroup analysis was performed to investigate the effect of vitamin D3 supplementation. Eighty-nine DFI patients were enrolled, with a median age of 55 years and a male predominance (89.9%). A significant association between vitamin D3 levels and clinical outcome was not observed (p = 0.66). A moderate correlation was observed with the neutrophil-lymphocyte ratio (r = 0.24, p = 0.02). Regarding QoL, emotions (domain) were significantly associated with vitamin D3 levels (p < 0.01). The subgroup analysis showed that vitamin D3 supplements did not affect the clinical outcome. The plasma vitamin D3 levels and vitamin D3 supplements do not significantly affect the biochemical, clinical, and humanistic outcomes, indicating vitamin D3 did not have a positive effect on DFI patients.

Aims/Introduction: Vitamin D deficiency is prevalent among individuals with diabetic foot infections (DFIs) and can influence a range of patient-related parameters. Hence, we aimed to find the association of serum vitamin D levels with various clinical, biochemical, and inflammatory parameters, as well as the microbial environment in the wounds of DFI patients. Materials and Methods: From September 2022 to March 2024, 169 DFI patients participated in cross-sectional research at the hospital. Utilising an electrochemiluminescence immunoassay, vitamin D levels were determined. Vitamin D receptor (VDR) and Cathelicidin (LL-37) were estimated using ELISA Kits. The tissue culture plate technique was used to analyze biofilm formation. Patient-related parameters were obtained from medical records. Results: The vitamin D status of DFI patients indicated that 70.4% were deficient, 19.5% were insufficient, and 10.1% were sufficient. The median vitamin D, VDR protein, and LL-37 values were 15.3 ng/mL, 0.832 ng/mL, and 1.54 ng/mL, respectively. Biofilm formation was seen in 84.36% of bacteria from vitamin D-deficient DFI patients ( P < .001). Vitamin D levels were negatively correlated with ulcer duration, hospital stay, white blood cell count, neutrophil-lymphocyte ratio, C-reactive protein, and systemic inflammation index (r = −0.787, −0.849, −0.6, −0.475, −0.402, and −0.521, respectively; P < .001). However, vitamin D levels were positively correlated with VDR and LL-37 levels (r = 0.988 and 0.944, respectively; P < .001). Conclusions: The majority of DFI patients exhibited vitamin D deficiency, which was significantly associated with most of the clinical, biochemical, and inflammatory parameters, in addition to the microbial environment within the wound.

Background/Objectives: Diabetic foot infections (DFIs) are a major cause of morbidity and lower-limb amputation. Vitamin D exerts immunomodulatory effects through vitamin D receptor (VDR), which regulates the cathelicidin antimicrobial peptide (CAMP) gene that encodes cathelicidin (LL-37). However, their association with DFIs remains poorly understood. This study investigated the association between vitamin D supplementation, the vitamin D–VDR–CAMP–LL-37 pathway, and ulcer healing in DFIs involving biofilm-forming bacteria. Methods: This study (September 2022–March 2026) included 16 DFI patients in the study group (SG), 16 in the reference group (RG), and 16 healthy controls (HCs). The SG received vitamin D supplementation (60,000 IU) in addition to standard care, whereas the RG received standard care alone. Participants were followed up for 4 months. Vitamin D assessment (electrochemiluminescence immunoassay), VDR and LL-37 quantification (ELISA), biofilm formation (tissue culture plate method), and VDR and CAMP gene expression (mRNA quantitation) were all considered. Results: At baseline, serum vitamin D, VDR protein, and LL-37 levels differed significantly among the groups (p ≤ 0.002), whereas VDR and CAMP gene expressions did not. Following supplementation, the SG showed significant increases in serum vitamin D, VDR protein and LL-37 (p ≤ 0.001). At the four-month follow-up, there was no significant difference in VDR and CAMP gene expression or in ulcer healing between the groups. Although a higher proportion of participants in the SG achieved ulcer healing, the difference was not statistically significant. Conclusions: Although changes in the circulating elements of the vitamin D-VDR-LL-37 pathway were noted with physician-prescribed vitamin D supplementation, no statistically significant association with ulcer healing was observed. This finding requires validation through a thorough investigation.