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.
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.
Statements
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.
References
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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).
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Summary
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
Volume
13 - 2022
Edited by
Attila Szabo, University of Oslo, Norway
Reviewed by
Manu Suresh Sharma, Yale University, United States
Updates
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 drnik.tondehal@gmail.com
†These authors have contributed equally to this work and share last authorship
This article was submitted to Molecular Psychiatry, a section of the journal Frontiers in Psychiatry
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.