{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T14:44:21Z","timestamp":1777301061264,"version":"3.51.4"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Secondary hyperparathyroidism (sHPT) and vitamin D deficiency are common comorbidities in adults with congenital heart disease (ACHD), but the relationship with lifestyle factors, and psychosocial health remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center cross-sectional study included 662 ACHD patients (mean age: 39.3\u202fyears; 47% female) and analyzed their clinical, psychosocial, and lifestyle data, including laboratory parameters, quality of life (QoL), and mental health metrics. Predictors of sHPT and vitamin D deficiency were evaluated using multivariate regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      sHPT was observed in 13% and vitamin D deficiency in 43.4% of patients. In the multivariate analysis, infrequent alcohol consumption (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), reduced QoL (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), fewer headaches (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), higher NYHA class (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), elevated NT-proBNP levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), metabolic syndrome (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), and lower exercise frequency (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) were independent predictors of sHPT. Reduced QoL (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), less frequent alcohol consumption (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), lower exercise frequency (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) and shorter exercise duration (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), as well as not living in a partnership (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01) were independent predictors of vitamin D deficiency.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights the multifactorial etiology of sHPT and vitamin D deficiency in ACHD, underscoring the roles of disease severity, lifestyle, and psychosocial factors. sHPT appears to be closely associated with advanced cardiac disease and heart failure and may serve as a marker of increased disease burden. Accordingly, assessment of sHPT may contribute to a more comprehensive risk stratification in ACHD. Further studies are needed to determine whether targeted interventions improve clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1681346","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T13:52:52Z","timestamp":1777297972000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of psychosocial factors on secondary hyperparathyroidism and vitamin D deficiency in adults with congenital heart disease\u2014the CHD-HYPER study"],"prefix":"10.3389","volume":"13","author":[{"given":"Friederike","family":"L\u00f6ffler","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten","family":"Linhorst","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justus Christian","family":"Garlichs","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Leitolf","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectiology and Endocrinology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Terkamp","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Infectiology and Endocrinology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Sophie","family":"Silber-Peest","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai G.","family":"Kahl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mechthild","family":"Westhoff-Bleck","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School","place":["Hannover, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1016\/j.jacc.2011.08.025","article-title":"Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis","volume":"58","author":"van der Linde","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1161\/CIRCULATIONAHA.110.946343","article-title":"Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium","volume":"122","author":"Moons","year":"2010","journal-title":"Circulation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.ahj.2012.07.023","article-title":"The prevalence of adult congenital heart disease, results from a systematic review and evidence based calculation","volume":"164","author":"van der Bom","year":"2012","journal-title":"Am Heart J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/S0735-1097(01)01272-4","article-title":"Task force 1: the changing profile of congenital heart disease in adult life","volume":"37","author":"Warnes Carole","year":"2001","journal-title":"JACC"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e001132","DOI":"10.1161\/JAHA.114.001132","article-title":"Metabolic syndrome in adults with congenital heart disease","volume":"5","author":"Deen","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"oeac055","DOI":"10.1093\/ehjopen\/oeac055","article-title":"Chronic kidney disease in patients with congenital heart disease: a nationwide, register-based cohort study","volume":"2","author":"Gilles\u00e9n","year":"2022","journal-title":"Eur Heart J Open"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.amjms.2017.02.008","article-title":"Secondary hyperparathyroidism in heart failure","volume":"354","author":"Morsy","year":"2017","journal-title":"Am J Med Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1111\/chd.12389","article-title":"Vitamin D kinetics and parathyroid gland function in patients with congenital heart disease","volume":"11","author":"Izumi","year":"2016","journal-title":"Congenit Heart Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"oeaf141","DOI":"10.1093\/ehjopen\/oeaf141","article-title":"Secondary hyperparathyroidism in adult congenital heart disease: the CHD-HYPER-study","volume":"5","author":"L\u00f6ffler","year":"2025","journal-title":"Eur Heart J Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.cca.2014.03.029","article-title":"PTH: potential role in management of heart failure","volume":"433","author":"Gruson","year":"2014","journal-title":"Clin Chim Acta"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1210\/endo-129-1-489","article-title":"Parathyroid hormone modulates angiotensin II-induced aldosterone secretion from the adrenal glomerulosa cell","volume":"129","author":"Isales","year":"1991","journal-title":"Endocrinology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/1744-9987.12679","article-title":"Association between parathyroid hormone and cardiovascular disease","volume":"22","author":"Fujii","year":"2018","journal-title":"Ther Apher Dial"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1159\/000168620","article-title":"Parathyroid hormone-parathyroid hormone related protein receptor messenger RNA is present in many tissues besides the kidney","volume":"13","author":"Tian","year":"1993","journal-title":"Am J Nephrol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"34","DOI":"10.17886\/RKI-GBE-2016-042","article-title":"Vitamin D status of adults in Germany","volume":"1","author":"Rabenberg","year":"2016","journal-title":"J Health Monit"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Vitamin D deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N Engl J Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1007\/s11914-017-0398-4","article-title":"Effects of excessive dietary phosphorus intake on bone health","volume":"15","author":"Vorland","year":"2017","journal-title":"Curr Osteoporos Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"51","DOI":"10.4161\/derm.24494","article-title":"Sunlight and vitamin D: a global perspective for health","volume":"5","author":"Wacker","year":"2013","journal-title":"Dermatoendocrinol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2328","DOI":"10.3390\/nu13072328","article-title":"The role of diet in bone and mineral metabolism and secondary hyperparathyroidism","volume":"13","author":"Bargagli","year":"2021","journal-title":"Nutrients"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s11926-008-0020-y","article-title":"Calcium and vitamin D: skeletal and extraskeletal health","volume":"10","author":"Khazai","year":"2008","journal-title":"Curr Rheumatol Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"10054","DOI":"10.1038\/s41598-023-35742-z","article-title":"Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and nutrition examination survey, 2011\u20132018","volume":"13","author":"Lin","year":"2023","journal-title":"Sci Rep"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1038\/sj.ejcn.1600870","article-title":"The influence of smoking on vitamin D status and calcium metabolism","volume":"53","author":"Brot","year":"1999","journal-title":"Eur J Clin Nutr"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e010946","DOI":"10.1136\/bmjopen-2015-010946","article-title":"Smoking and serum vitamin D in older Chinese people: cross-sectional analysis based on the Guangzhou biobank cohort study","volume":"6","author":"Jiang","year":"2016","journal-title":"BMJ Open"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1001\/archpsyc.65.5.508","article-title":"Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults","volume":"65","author":"Hoogendijk","year":"2008","journal-title":"Arch Gen Psychiatry"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/j.ahj.2010.03.017","article-title":"Association of vitamin D levels with incident depression among a general cardiovascular population","volume":"159","author":"May","year":"2010","journal-title":"Am Heart J"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"E1379","DOI":"10.21037\/jtd.2016.10.66","article-title":"Quality of life in adults with congenital heart disease: what matters?","volume":"8","author":"Kahl","year":"2016","journal-title":"J Thorac Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"7451","DOI":"10.3390\/jcm14207451","article-title":"Quality of life in adults with congenital heart disease: insights from a tertiary Centre","volume":"14","author":"Kacar","year":"2025","journal-title":"J Clin Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.jacc.2006.03.041","article-title":"Estimates of life expectancy by adolescents and young adults with congenital heart disease","volume":"48","author":"Reid","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.bone.2015.04.012","article-title":"Deficits in bone density and structure in children and young adults following Fontan palliation","volume":"77","author":"Avitabile","year":"2015","journal-title":"Bone"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s44231-022-00025-0","article-title":"Clinical features and prognosis of severe secondary hyperparathyroidism: a retrospective study from a single center","volume":"3","author":"Duan","year":"2023","journal-title":"Intensive Care Res"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1207\/s15327752jpa6601_2","article-title":"UCLA loneliness scale (version 3): reliability, validity, and factor structure","volume":"66","author":"Russell","year":"1996","journal-title":"J Pers Assess"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1177\/2047487319865055","article-title":"Diagnostic evaluation of the hospital depression scale (HADS) and the Beck depression inventory II (BDI-II) in adults with congenital heart disease using a structured clinical interview: impact of depression severity","volume":"27","author":"Westhoff-Bleck","year":"2020","journal-title":"Eur J Prev Cardiol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"987","DOI":"10.3275\/8286","article-title":"Increased circulating concentrations of bioactive PTH 1-84 in patients with heart failure","volume":"35","author":"Gruson","year":"2012","journal-title":"J Endocrinol Investig"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"100521","DOI":"10.1016\/j.ijcchd.2024.100521","article-title":"Vitamin D deficiency and secondary hyperparathyroidism in adult Fontan patients","volume":"17","author":"L\u00f6ffler","year":"2024","journal-title":"Int J Cardiol Congenital Heart Dis"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1093\/eurjhf\/hfq134","article-title":"Plasma parathyroid hormone and risk of congestive heart failure in the community","volume":"12","author":"Hagstr\u00f6m","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1016\/j.jacc.2011.03.069","article-title":"Vitamin D, parathyroid hormone, and cardiovascular events among older adults","volume":"58","author":"Kestenbaum","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1093\/eurjhf\/hfr016","article-title":"Parathyroid hormone and vitamin D--markers for cardiovascular and all cause mortality in heart failure","volume":"13","author":"Schierbeck","year":"2011","journal-title":"Eur J Heart Fail"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"100238","DOI":"10.1016\/j.clinme.2024.100238","article-title":"Secondary hyperparathyroidism in chronic kidney disease: a narrative review focus on therapeutic strategy","volume":"24","author":"Tsai","year":"2024","journal-title":"Clin Med"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"10.12688\/f1000research.22636.1","DOI":"10.12688\/f1000research.22636.1","article-title":"Recent advances in understanding and managing secondary hyperparathyroidism in chronic kidney disease","volume":"9","author":"Rodr\u00edguez-Ortiz","year":"2020","journal-title":"F1000Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e001132","DOI":"10.1161\/JAHA.114.001132","article-title":"Metabolic syndrome in adults with congenital heart disease","volume":"5","author":"Deen","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.amjcard.2022.05.031","article-title":"Prevalence of metabolic syndrome in young adults with congenital heart disease","volume":"179","author":"Umapathi","year":"2022","journal-title":"Am J Cardiol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s13098-023-01062-5","article-title":"Longitudinal associations between physical activity and five risk factors of metabolic syndrome in middle-aged adults in Germany","volume":"15","author":"Cleven","year":"2023","journal-title":"Diabetol Metab Syndr"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1161\/CIRCRESAHA.118.312669","article-title":"Sedentary behavior, exercise, and cardiovascular health","volume":"124","author":"Lavie","year":"2019","journal-title":"Circ Res"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1016\/j.jacc.2016.03.477","article-title":"Quality of life of adults with congenital heart disease in 15 countries: evaluating country-specific characteristics","volume":"67","author":"Apers","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.jad.2016.06.047","article-title":"Mental disorders in adults with congenital heart disease: unmet needs and impact on quality of life","volume":"204","author":"Westhoff-Bleck","year":"2016","journal-title":"J Affect Disord"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"806981","DOI":"10.3389\/fped.2021.806981","article-title":"Screen time, age and sunshine duration rather than outdoor activity time are related to nutritional vitamin D status in children with ASD","volume":"9","author":"Shan","year":"2022","journal-title":"Front Pediatr"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1093\/nutrit\/nuy067","article-title":"Diet quality of vegetarian diets compared with nonvegetarian diets: a systematic review","volume":"77","author":"Parker","year":"2019","journal-title":"Nutr Rev"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/1472-6874-13-33","article-title":"Determinants of serum levels of vitamin D: a study of life-style, menopausal status, dietary intake, serum calcium, and PTH","volume":"13","author":"Shirazi","year":"2013","journal-title":"BMC Womens Health"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s00394-017-1415-1","article-title":"Associations of vitamin D status with dietary intakes and physical activity levels among adults from seven European countries: the Food4Me study","volume":"57","author":"Manios","year":"2018","journal-title":"Eur J Nutr"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"S54","DOI":"10.1177\/0022146510383501","article-title":"Social relationships and health: a flashpoint for health policy","volume":"51","author":"Umberson","year":"2010","journal-title":"J Health Soc Behav"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1192\/bjp.bp.111.106666","article-title":"Vitamin D deficiency and depression in adults: systematic review and meta-analysis","volume":"202","author":"Anglin","year":"2013","journal-title":"Br J Psychiatry"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1001\/archinte.167.11.1159","article-title":"Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the third National Health and nutrition examination survey","volume":"167","author":"Martins","year":"2007","journal-title":"Arch Intern Med"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1681346\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T13:52:55Z","timestamp":1777297975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1681346\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":53,"alternative-id":["10.3389\/fnut.2026.1681346"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1681346","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"article-number":"1681346"}}