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45 protocols using radioimmunoassay kit

1

Periodontal Status and Vitamin D Levels

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Periodontal examination applied the FMPE protocol, which collects probe measurements from six sites per tooth for all teeth in NHANES. Accordingly, the CDC/AAP definitions were based on measures of AL and PD at the four interproximal sites per tooth [17 (link)] Severe periodontitis was characterized as: ≥ 2 interproximal sites with attachment loss (AL) ≥ 6 mm (not on the same tooth) and ≥ 1 interproximal site with probing depth (PD) ≥ 5 mm. Mild periodontitis, moderate periodontitis, and no periodontitis definitions were described in Additional file 1: Table S1.
Using the standard protocol, serum 25(OH)D levels were tested in blood samples collected through venipuncture at mobile examination centers (MEC). Serum 25(OH)D was measured via DiaSorin radioimmunoassay kit (Diasorin, Stillwater, MN, USA) at the National Center for Environmental Health, Center for Disease Control and Prevention. As in previous studies, the serum 25(OH)D levels were classified as normal (≥ 75 nmol/ml), insufficient (50–74.9 nmol/ml), deficient (25–49.9 nmol/ml), and severely deficient (< 25 nmol/ml) [16 (link)].
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2

NHANES Serum 25(OH)D Measurement Protocol

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Serum specimens were collected from participants at a specifically designed and equipped MEC. The NHANES Laboratory Procedures Manual (https://www.cdc.gov/nchs/data/nhanes/2017-2018/manuals/2017-MEC-Laboratory-Procedures-Manual.pdf; accessed on May 3, 2023) provides detailed instructions on specimen collection and processing. In this study, the serum 25(OH)D concentration was measured using the Diasorin radioimmunoassay kit (Stillwater, MN, USA). To ensure comparability across different survey cycles of NHANES, a regression method was used to convert the data into equivalent 25(OH)D measurements based on the established liquid chromatography-tandem mass spectrometry (LC-MS/MS) technique. This technique has been used for the analysis of circulating 25(OH)D data since 2007. The NCHS of the Centers for Disease Control and Prevention recommends using the LC-MS/MS-equivalent data for all analyses across different survey cycles of NHANES. More information is accessible online via the following link: https://www.cdc.gov/nchs/nhanes/vitamin_D/analyticalnote.aspx (accessed on May 3, 2023).
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3

Serum 25(OH)D Measurement in NHANES

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NHANES 2001–2006, serum 25(OH)D concentration was measured by DiaSorin radioimmunoassay kit (Stillwater, MN), but the data was converted to equivalent 25(OH)D measured value from LC-MS/MS method by regression method. From 2007 to 2010, serum 25(OH)D concentration was measured by a standardized liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The CDC LC-MS/MS method has better analytical specificity and sensitivity compared to immunoassay methods, and fixed analytical goals for imprecision ( ≤ 10%) and bias ( ≤ 5%).
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4

Comprehensive Metabolic Panel in Dialysis

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Routine laboratory tests using fasting blood samples were performed before dialysis. Serum levels of hemoglobin, glucose, blood urea nitrogen, creatinine, albumin, calcium, phosphorus, alkaline phosphatase (ALP), C-reactive protein, parathyroid hormone (PTH), total cholesterol, triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were analyzed. Serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were assessed using a radioimmunoassay kit (DiaSorin Inc., Stillwater, MN). Fetuin-A, osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) levels were analyzed with enzyme-linked immunosorbent assay (ELISA, BioVendor Laboratory Medicine, Modrice, Czech Republic). We additionally measured fibroblast growth factor 23 (FGF-23) levels using a Millipore FGF23 ELISA Kit (Millipore Co., Billerica, MA).
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5

Serum Biomarkers for Metabolic Health

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Blood samples were obtained in the morning following an overnight fast. The serum concentrations of glucose, high-density lipoprotein cholesterol (HDL), triglycerides, aspartate transaminase (AST), and alanine transaminase (ALT) were measured using a Hitachi automatic analyzer 7600 (Tokyo, Japan). Low-density lipoprotein cholesterol (LDL) was measured directly using a Hitachi automatic analyzer 7600. Serum C-reactive proteins were measured with an ELISA kit (Abcam, Cambridge, UK). Serum 25-OH-D levels, as an indicator of vitamin D status, were measured with a radioimmunoassay kit (DiaSorin, Stillwater, MN, USA) using a 1470 Wizard gamma counter (Perkin–Elmer, Turku, Finland). All clinical analyses were performed by the Neodin Medical Institute, a laboratory certified by the Korean Ministry of Health and Welfare.
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6

Vitamin D Deficiency Measurement

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Plasma samples were assayed for 25-hydroxyvitamin D3 using a radioimmunoassay kit (DiaSorin, Stillwater, MN, USA), and vitamin D deficiency was defined as plasma levels of 25-hydroxyvitamin D3 lower than 20 ng/mL.19 (link)
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7

Comprehensive Metabolic Profiling of Fasting Samples

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Blood samples were obtained after 12 h or more fasting. HbA1c from whole blood, plasma glucose concentrations, and serum concentrations of total and HDL-cholesterol and triglycerides were measured using an automatic analyzer (ZEUS 9.9; Takeda, Tokyo, Japan). Serum LDL cholesterol concentrations were calculated by the Freidman equation. Serum insulin concentrations were measured using a gamma counter (1470 Wizard; Perkin-Elmer, San Jose, CA, USA) with a radioimmunoassay kit (DiaSorin, Stillwater, MN, USA). Homeostasis model assessment estimates (HOMA) were used to estimate beta (B) cell capacity (HOMA-B) and insulin resistance (HOMA-IR). HOMA assessments were calculated as previously described [15 (link)]. Systolic (SBP) and diastolic blood pressure (DBP) were measured three times on the right arm at the same height as their heart in a sitting position with a 1 min interval between measurements; we used the averages of the three measurements of SBP and DBP. Serum C-reactive protein (CRP) was measured by ELISA kit.
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8

Fasting Blood Analysis for Metabolic Markers

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Venous blood samples were collected the morning after PSG following at least 8 h of fasting. Biochemical parameters of renal function and lipid profile, as well as glucose and C‐reactive protein (CRP) serum levels were measured using an automated analyser. Serum biochemical parameters were determined using a commercial radioimmunoassay kit and the manufacturer's specifications the day of blood sampling (DiaSorin, Stillwater, MN, USA).
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9

Serum Biomarker Measurement Protocol

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Serum cholesterol, triglycerides, creatinine and urea were measured using an automatic analyser Integra 800 (Roche Diagnostic, Mannheim, Germany). Plasma renin activity was measured with a commercially available radioimmunoassay kit (DiaSorin, Stillwater, MN, USA).
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10

Measuring Serum Vitamin D Levels

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Blood specimens were collected after an 8-hour fast and were centrifuged to isolate the serum. The concentration of 25(OH)D, with equimolar measurements of 25(OH)D2 and 25(OH)D3, which is a marker of vitamin D status, was measured using a radioimmunoassay kit (DiaSorin, Stillwater, MN, USA) using the 1470 WIZARD gamma-Counter (PerkinElmer, Turku, Finland). The KCDC continuously monitored and checked 25(OH)D levels via internal and external quality control. Internal quality control, using the Westgard multi-rule control method, is performed to evaluate the precision and accuracy of an analytical system using mean, standard deviation (SD), and coefficient of variation (%) values. The coefficient of variation for the control material was <7.6% for the low level and <5.8% for the high level. External quality control was evaluated using the Vitamin D Quality Assessment Scheme, Vitamin D Metabolites Quality Assurance Program of the National Institute of Standards and Technology, Accuracy-based Vitamin D Survey of College of American Pathologists.17 The participants were divided into the following three categories according to their 25(OH)D concentration based on established definitions and practical guidelines: vitamin D deficient (<10 ng/mL), insufficient (10–19.99 ng/mL), and sufficient (≥20 ng/mL).18 (link),19 (link)
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