have shown, Nlrp3 inflammasome but not the Nlrc4 inflammasome impacts microbiota in the gut which in turn modulated development of NASH with MCDD
. This could also be a mechanism by which [Nlrp3.sup.-/-] mice have increased liver injury with alcohol consumption, while [Nlrc.4.sup.-/-] mice have similar injury to B6 mice in our study.
Moreover, many medications commonly taken by people with ID, as well as by those with medically complex developmental disabilities (MCDD), further decrease blood vitamin D levels, requiring them to take higher amounts of vitamin D.
Based on the currently accepted minimum levels of vitamin D in "healthy" people, approximately 80 percent of persons with MCDD are vitamin D insufficient [serum 25(OH)D levels below 30 ng/mL], and more than 50 percent are vitamin D deficient [serum 25(OH)D levels below 20 ng/mL].
However, for special populations, such as institutionalized persons, PIDs, those with MCDD, and anyone receiving certain medications, such as anti-epileptic or psychotropic agents, a minimum level of 40 ng/mL (100 nmol/L) with the optimal range between 40 to 60 ng/mL is recommended.
Therefore, there is no hazard in treating PIDD and MCDD using vitamin D dosages between 2,000 and 5,000 IU a day or 50,000 IU administered two to three times a month.
Consequentially, compared with the healthy population, people with MCDD have a higher incidence of osteomalacia, falls and fractures.
Although the majority of persons with MCDD have low bone mass, this does not necessarily obligate treating all of them with potent anti-osteoporosis therapies such as bisphosphonates or denosumab, unless it is the main cause of their fractures.