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Yang W, Ge M, Wang Y, Pang X, Wang C. Spatial distribution differences of 25-hydroxyvitamin D in healthy elderly people under the influence of geographical environmental factors. Sci Rep 2022; 12:12781. [PMID: 35896722 PMCID: PMC9326152 DOI: 10.1038/s41598-022-17198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/21/2022] [Indexed: 11/09/2022] Open
Abstract
The main targets of this were to screen the factors that may influence the distribution of 25-hydroxyvitamin D[25(OH)D] reference value in healthy elderly people in China, and further explored the geographical distribution differences of 25(OH)D reference value in China. In this study, we collected the 25(OH)D of 25,470 healthy elderly from 58 cities in China to analyze the correlation between 25(OH)D and 22 geography secondary indexes through spearman regression analysis. Six indexes with significant correlation were extracted, and a ridge regression model was built, and the country’s urban healthy elderly’25(OH)D reference value was predicted. By using the disjunctive Kriging method, we obtained the geographical distribution of 25(OH)D reference values for healthy elderly people in China. The reference value of 25(OH)D for healthy elderly in China was significantly correlated with the 6 secondary indexes, namely, latitude (°), annual temperature range (°C), annual sunshine hours (h), annual mean temperature (°C), annual mean relative humidity (%), and annual precipitation (mm). The geographical distribution of 25(OH)D values of healthy elderly in China showed a trend of being higher in South China and lower in North China, and higher in coastal areas and lower in inland areas. This study lays a foundation for further research on the mechanism of different influencing factors on the reference value of 25(OH)D index. A ridge regression model composed of significant influencing factors has been established to provide the basis for formulating reference criteria for the treatment factors of the vitamin D deficiency and prognostic factors of the COVID-19 using 25(OH)D reference value in different regions.
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Affiliation(s)
- Wenjie Yang
- Institute of Health Geography, School of Geographical Sciences and Tourism, Shaanxi Normal University, Xi'an, 710119, Shaanxi, China
| | - Miao Ge
- Institute of Health Geography, School of Geographical Sciences and Tourism, Shaanxi Normal University, Xi'an, 710119, Shaanxi, China.
| | - Yabo Wang
- Institute of Health Geography, School of Geographical Sciences and Tourism, Shaanxi Normal University, Xi'an, 710119, Shaanxi, China
| | - Xinrui Pang
- Institute of Health Geography, School of Geographical Sciences and Tourism, Shaanxi Normal University, Xi'an, 710119, Shaanxi, China
| | - Congxia Wang
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710119, Shaanxi, China
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Liu W, Hu J, Fang Y, Wang P, Lu Y, Shen N. Vitamin D status in Mainland of China: A systematic review and meta-analysis. EClinicalMedicine 2021; 38:101017. [PMID: 34308318 PMCID: PMC8283334 DOI: 10.1016/j.eclinm.2021.101017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low vitamin D (VitD) status is becoming a global health issue. Previous heterogenous results are urging a meta-analysis to delineate a panorama of VitD conditions in the general population in Mainland of China. METHODS We performed a systematic review and meta-analysis by searching PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, WanFang, and VIP databases up to June 4, 2021. The inclusion criteria were as follows: (1) original articles or dissertations focused on VitD status of people in Mainland of China; and (2) studies were population-based, cross-sectional, or longitudinal cohort with baseline data. The outcomes were serum 25(OH)D concentration and the prevalence of low VitD status. Low VitD status included VitD deficiency (< 30 nmol/L) and VitD inadequacy (< 50 nmol/L). Data were estimated by Hierarchical Bayesian methods. All included studies were cross-sectional or longitudinal cohort studies about VitD status of people in Mainland of China. (Registration: PROSPERO CRD42021226130). FINDINGS A total of 105 eligible studies including 234,519 subjects were included. In adults, the overall mean 25(OH)D concentration was 44.3 nmol/L (95% Credible Interval [CrI]: 39.8-48.7). The pooled prevalence of VitD deficiency and inadequacy was 20.7% (95% CrI: 11.9-32.9) and 63.2% (95% CrI: 53.5-72.3), respectively. In children and adolescents, the overall mean 25(OH)D concentration was 52.2 nmol/L (95% CrI: 46.7-57.5). The pooled prevalence of VitD deficiency and inadequacy was 23.0% (95% CrI: 8.9-44.3) and 46.8% (95% CrI: 37.2-56.6), respectively. Specially, we identified that the prevalence of VitD inadequacy increased with age in populations with age ≤ 18 years and ≥ 60 years. INTERPRETATION Low VitD status is prominent in general population of Mainland of China, especially for adults. FUNDING National Major Scientific and Technological Special Project for "Significant New Drugs Development" (2017ZX09304022).
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Affiliation(s)
- Wenhua Liu
- Clinical Research Center,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Jing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, HUST, Wuhan, China
| | - Yuanyuan Fang
- Department of Neurology, Tongji Hospital,Tongji Medical College, HUST, Wuhan, China
| | - Peng Wang
- Institute and Department of Infectious Disease, Tongji Hospital, Tongji Medical College, HUST, Wuhan, China
| | - Yanjun Lu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, HUST, Wuhan, China
| | - Na Shen
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, HUST, Wuhan, China
- Corresponding author.
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Bejar CA, Goyal S, Afzal S, Mangino M, Zhou A, van der Most PJ, Bao Y, Gupta V, Smart MC, Walia GK, Verweij N, Power C, Prabhakaran D, Singh JR, Mehra NK, Wander GS, Ralhan S, Kinra S, Kumari M, de Borst MH, Hyppönen E, Spector TD, Nordestgaard BG, Blackett PR, Sanghera DK. A Bidirectional Mendelian Randomization Study to evaluate the causal role of reduced blood vitamin D levels with type 2 diabetes risk in South Asians and Europeans. Nutr J 2021; 20:71. [PMID: 34315477 PMCID: PMC8314596 DOI: 10.1186/s12937-021-00725-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Context Multiple observational studies have reported an
inverse relationship between 25-hydroxyvitamin
D concentrations (25(OH)D) and type 2 diabetes (T2D). However, the results of
short- and long-term interventional trials concerning the relationship between 25(OH)D and T2D risk have been
inconsistent. Objectives and methods To evaluate the causal role of reduced blood
25(OH)D in T2D, here we have performed a bidirectional Mendelian randomization
study using 59,890 individuals (5,862 T2D cases and 54,028 controls) from
European and Asian Indian ancestries. We used six known SNPs, including three
T2D SNPs and three vitamin D pathway SNPs, as a genetic instrument to evaluate
the causality and direction of the association between T2D and circulating
25(OH)D concentration. Results Results of the combined meta-analysis of eight
participating studies showed that a composite score of three T2D SNPs would
significantly increase T2D risk by an odds ratio (OR) of 1.24, p = 1.82 × 10–32; Z score 11.86, which, however, had
no significant association with 25(OH)D status (Beta -0.02nmol/L ± SE
0.01nmol/L; p = 0.83; Z score -0.21). Likewise, the genetically
instrumented composite score of 25(OH)D lowering alleles significantly
decreased 25(OH)D concentrations (-2.1nmol/L ± SE 0.1nmol/L,
p = 7.92 × 10–78; Z score -18.68) but was not
associated with increased risk for T2D (OR 1.00, p = 0.12;
Z score 1.54). However, using 25(OH)D synthesis SNP (DHCR7; rs12785878) as an
individual genetic instrument, a per allele reduction of 25(OH)D concentration
(-4.2nmol/L ± SE 0.3nmol/L)
was predicted to increase T2D risk by 5%, p = 0.004;
Z score 2.84. This effect, however, was not seen in other 25(OH)D SNPs (GC
rs2282679, CYP2R1 rs12794714) when used as an individual instrument. Conclusion Our new data on this bidirectional Mendelian
randomization study suggests that genetically instrumented T2D risk does not
cause changes in 25(OH)D levels. However, genetically regulated 25(OH)D
deficiency due to vitamin D synthesis gene (DHCR7) may influence the risk of
T2D. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00725-1.
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Affiliation(s)
- Cynthia A Bejar
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd., Rm 317 BMSB, OK, 73104, OK City, USA
| | - Shiwali Goyal
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd., Rm 317 BMSB, OK, 73104, OK City, USA
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, SE1 7EH, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, SE1 9RT, London, UK
| | - Ang Zhou
- Australian Center for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia
| | - Peter J van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, NL, The Netherlands
| | - Yanchun Bao
- Department of Mathematical Sciences, University of Essex, Colchester, UK
| | - Vipin Gupta
- Department of Anthropology, University of Delhi, New Delhi, India
| | - Melissa C Smart
- Department of Mathematical Sciences, University of Essex, Colchester, UK
| | | | - Niek Verweij
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christine Power
- Population, Policy and Practice, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | | | - Jai Rup Singh
- Department of Human Genetics, Central University of Punjab, Bathinda, Punjab, India
| | - Narinder K Mehra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences and Research, New Delhi, India
| | | | - Sarju Ralhan
- Department of Cardiology, Hero DMC Heart Institute, Ludhiana, India
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Meena Kumari
- Department of Mathematical Sciences, University of Essex, Colchester, UK
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elina Hyppönen
- Australian Center for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia.,Population, Policy and Practice, Institute of Child Health, University College London, London, WC1N 1EH, UK.,Australian Centre for Precision Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, SE1 7EH, UK
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Piers R Blackett
- Department of Pediatrics, Section of Pediatric Endocrinology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dharambir K Sanghera
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd., Rm 317 BMSB, OK, 73104, OK City, USA. .,Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. .,Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. .,Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. .,Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Wang Q, Ma A, Schouten EG, Kok FJ. A double burden of tuberculosis and diabetes mellitus and the possible role of vitamin D deficiency. Clin Nutr 2020; 40:350-357. [PMID: 32948348 DOI: 10.1016/j.clnu.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 01/19/2023]
Abstract
Tuberculosis remains a major global health challenge, particularly in low-to-middle income countries such as China. At the same time, the country is facing a rapidly increasing diabetes incidence over the last 10 years. Diabetes aggravates the tuberculosis epidemic which poses a serious challenge in public health. In recent years, the high prevalence of vitamin D deficiency represents a global health problem, which is also associated with the risk of diabetes, and tuberculosis. Therefore, this review aims to provide an overall and updated understanding of the epidemiology of co-occurrence of tuberculosis and diabetes in China, and to elucidate the possible role of vitamin D deficiency. In conclusion, significant aggravation of the tuberculosis epidemic due to diabetes may exist in China for a relatively long period of time to come. Further, the double burden and its implications to public health in this country may be significantly influenced by the high prevalence of vitamin D deficiency. Bidirectional screening for tuberculosis and diabetes is recommended, and extra vitamin D may benefit especially in a situation of a heavy tuberculosis burden combined with prevalent vitamin D deficiency. Longitudinal studies to verify the role of vitamin D deficiency in the double burden, and trials on the effect of vitamin D supplementation are needed in the future.
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Affiliation(s)
- Qiuzhen Wang
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China.
| | - Aiguo Ma
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Evert G Schouten
- Division of Nutrition and Health, Wageningen University&Research, Wageningen, the Netherlands
| | - Frans J Kok
- Division of Nutrition and Health, Wageningen University&Research, Wageningen, the Netherlands
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Li H, Huang T, Xiao P, Zhao X, Liu J, Cheng H, Dong H, Morris HA, Mi J. Widespread vitamin D deficiency and its sex-specific association with adiposity in Chinese children and adolescents. Nutrition 2019; 71:110646. [PMID: 31896064 DOI: 10.1016/j.nut.2019.110646] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/31/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Vitamin D is involved in various physiologic and pathologic processes in the human body. The aim of this study was to determine the prevalence of vitamin D deficiency and the association of adiposity indicators with 25-hydroxyvitamin D (25[OH]D) in Chinese children and adolescents. METHODS This was a population-based, nationwide, multicenter cross-sectional study involving 10 696 participants (51.2% boys) 6 to 18 y of age. Total body fat mass was assessed by dual-energy x-ray absorptiometry, and measures of body mass index (BMI), fat mass index (FMI), fat mass percentage (FMP), and plasma 25(OH)D concentrations were obtained. RESULTS The adjusted mean of 25(OH)D was 39.3 nmol/L for all participants, 40.7 nmol/L for boys, and 37.9 nmol/L for girls. Of the children, 30% had vitamin D deficiency (25[OH]D <30 nmol/L) and 80% had vitamin D insufficiency (25[OH]D <50 nmol/L). The prevalence rates of vitamin D deficiency and insufficiency were higher in girls (31%, 83.4%, respectively) than in boys (22.8%, 78.7%, respectively). An L-shape relationship between age and 25(OH)D was observed in all children, with a threshold age of 14 y. Also, there was an inverted U-shaped association of BMI with 25(OH)D, and multivariable linear models shown FMI and FMP were inversely associated with 25(OH)D concentrations, particularly in boys (β = -0.86 and -0.83, respectively, all P < 0.05). CONCLUSIONS Vitamin D deficiency was widespread and its sex-specific association with an excess of body fat in Chinese children and adolescents. The findings indicate that targeted screening and treatment guidelines may be useful.
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Affiliation(s)
- Haibo Li
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Pei Xiao
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoyuan Zhao
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Junting Liu
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Hong Cheng
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Hongbo Dong
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Howard A Morris
- School of Pharmacy and Medical Sciences, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Jie Mi
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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The Relationship Between Vitamin D Status and Bone Mineral Density in the Elderly: A Systematic Review. PHYSICAL ACTIVITY AND HEALTH 2019. [DOI: 10.5334/paah.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vitamin D Status of Residents in Taiyuan, China and Influencing Factors. Nutrients 2017; 9:nu9080898. [PMID: 28820448 PMCID: PMC5579691 DOI: 10.3390/nu9080898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 02/07/2023] Open
Abstract
High prevalence of vitamin D deficiency has been reported worldwide. Residents of Taiyuan, China, were predicted to be at high risk of vitamin D deficiency due to its high latitude, heavy air pollution, and cultural sun avoidance. This study investigated the vitamin D status of office workers, and explored the potential determinants of capillary 25-hydroxyvitamin D (25(OH)D) concentration as well as the relationship between 25(OH)D and metabolic syndrome. Two hundred participants, aged 20 to 80 years, were recruited. Capillary dried blood spot (DBS) 25(OH)D was measured; together with anthropometric (height, weight, and waist circumference), biochemical (serum lipid profile and fasting glucose) measures and a lifestyle questionnaire. Thirty-four percent of participants had 25(OH)D concentrations below 30 nmol/L, indicating deficient vitamin D status. Women’s 25(OH)D (median; 32.7 nmol/L (upper and lower quartile; 25.8, 43.8)) was significantly lower than men (44.0 nmol/L (32.3, 55.4)) (p < 0.01). Female gender, higher fasting glucose, and increased smoking (p < 0.05) were negatively associated with 25(OH)D concentration. However, there was no association found between metabolic syndrome (MetS) and 25(OH)D concentration and no significant difference in vitamin D status between men or women with MetS compared to healthy individuals. Vitamin D deficiency was common in urban residents of Taiyuan in winter and more so in women than men.
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Man PW, Lin W, van der Meer IM, Heijboer AC, Wolterbeek R, Numans ME, Middelkoop BJC, Lips P. Vitamin D status in the Chinese population in the Netherlands: The DRAGON study. J Steroid Biochem Mol Biol 2016; 164:194-198. [PMID: 26690788 DOI: 10.1016/j.jsbmb.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/29/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Vitamin D is essential for bone health since it stimulates the intestinal absorption of calcium and phosphorus from the gut, both necessary for bone mineralization. However, vitamin D deficiency is highly prevalent among several non-Western immigrant populations in the Netherlands. To date, there are no data available of the vitamin D status in the Chinese population residing in the Netherlands. Therefore, an observational study was performed to determine 25-hydroxyvitamin D (25(OH)D) concentrations and to assess potential determinants of low vitamin D status. METHODS Subjects, aged 18 years and older, with a Chinese background and residing in the Netherlands were invited to participate in the study. A questionnaire was used to assess general characteristics and lifestyle habits. Fasting blood samples were obtained in March 2014 to measure serum 25(OH)D concentration, and analysed by liquid chromatography tandem mass spectrometry. RESULTS 418 subjects participated in the study, 104 men and 314 women. The mean age for both men and women was 56 years. Serum 25(OH)D concentration <50nmol/L was more prevalent in men than in women (67.9% and 53.1%, respectively; p=0.008). The percentage of serum 25(OH)D concentration<25nmol/L in men and women was 5.8% and 10.9%, respectively. Multiple logistic regression analysis, adjusted for age and gender, revealed that non-use of vitamin D supplements and fewer days per week of physical activity were significant predictors of serum 25(OH)D levels below 50nmol/L. CONCLUSIONS Within the Chinese population living in the Netherlands, serum 25(OH)D concentration was below 50nmol/L in 68% of men and 53% of women. Use of vitamin D supplements by Chinese people in the Netherlands was highly protective against low 25(OH)D levels.
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Affiliation(s)
- Ping Wai Man
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - Wenzhi Lin
- Medical Center Balans, The Hague, The Netherlands
| | - Irene M van der Meer
- Department of Epidemiology, Municipal Health Service Haaglanden, The Hague, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, Amsterdam, The Netherlands
| | - Ron Wolterbeek
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Barend J C Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Epidemiology, Municipal Health Service Haaglanden, The Hague, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, The Netherlands
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Redmond J, Fulford AJ, Jarjou L, Zhou B, Prentice A, Schoenmakers I. Diurnal Rhythms of Bone Turnover Markers in Three Ethnic Groups. J Clin Endocrinol Metab 2016; 101:3222-30. [PMID: 27294326 PMCID: PMC4971334 DOI: 10.1210/jc.2016-1183] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Ethnic groups differ in fragility fracture risk and bone metabolism. Differences in diurnal rhythms (DRs) of bone turnover and PTH may play a role. OBJECTIVE We investigated the DRs of plasma bone turnover markers (BTMs), PTH, and 1,25(OH)2D in three groups with pronounced differences in bone metabolism and plasma PTH. PARTICIPANTS Healthy Gambian, Chinese, and white British adults (ages 60-75 years; 30 per country). INTERVENTIONS Observational study with sample collection every 4 hours for 24 hours. MAIN OUTCOMES Levels of plasma C-terminal telopeptide of type I collagen, procollagen type-1 N-propeptide, N-mid osteocalcin, bone alkaline phosphatase, PTH, and 1,25-dihydroxyvitamin D were measured. DRs were analyzed with random-effects Fourier regression and cross-correlation and regression analyses to assess associations between DRs and fasting and 24-hour means of BTMs and PTH. RESULTS Concentrations of BTMs, PTH, and 1,25-dihydroxyvitamin D were higher in Gambians compared to other groups (P < .05). The DRs were significant for all variables and groups (P < .03) and were unimodal, with a nocturnal peak and a daytime nadir for BTMs, whereas PTH had two peaks. The DRs of BTMs and PTH were significantly cross-correlated for all groups (P < .05). There was a significant positive association between C-terminal telopeptide of type I collagen and PTH in the British and Gambian groups (P = .03), but not the Chinese group. CONCLUSIONS Despite ethnic differences in plasma BTMs and PTH, DRs were similar. This indicates that alteration of rhythmicity and loss of coupling of bone resorption and formation associated with an elevated PTH in other studies may not uniformly occur across different populations and needs to be considered in the interpretation of PTH as a risk factor of increased bone loss.
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Affiliation(s)
- Jean Redmond
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Anthony J Fulford
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Landing Jarjou
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Bo Zhou
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Ann Prentice
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
| | - Inez Schoenmakers
- Medical Research Council (MRC) Human Nutrition Research (J.R., A.P., I.S.), Cambridge CB1 9NL, United Kingdom; MRC Keneba (A.J.F., L.J., A.P.), Banjul, The Gambia; MRC International Nutrition Group (A.J.F.), London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; and Department of Public Health (B.Z.), Shenyang Medical College, Shenyang 110034, People's Republic of China
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Sapkota BR, Hopkins R, Bjonnes A, Ralhan S, Wander GS, Mehra NK, Singh JR, Blackett PR, Saxena R, Sanghera DK. Genome-wide association study of 25(OH) Vitamin D concentrations in Punjabi Sikhs: Results of the Asian Indian diabetic heart study. J Steroid Biochem Mol Biol 2016; 158:149-156. [PMID: 26704534 PMCID: PMC4769937 DOI: 10.1016/j.jsbmb.2015.12.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/22/2015] [Accepted: 12/11/2015] [Indexed: 01/01/2023]
Abstract
Vitamin D deficiency is implicated in multiple disease conditions and accumulating evidence supports that the variation in serum vitamin D (25(OH)D) levels, including deficiency, is under strong genetic control. However, the underlying genetic mechanism associated with vitamin 25(OH)D concentrations is poorly understood. We earlier reported a very high prevalence of vitamin D deficiency associated with an increased risk for type 2 diabetes and obesity in a Punjabi Sikh diabetic cohort as part of the Asian Indian diabetic heart study (AIDHS). Here we have performed the first genome-wide association study (GWAS) of serum 25(OH)D on 3538 individuals from this Punjabi Sikh population. Our discovery GWAS comprised of 1387 subjects followed by validation of 24 putative SNPs (P<10(-4)) using an independent replication sample (n=2151) from the same population by direct genotyping. A novel locus at chromosome 20p11.21 represented by rs2207173 with minor allele frequency (MAF) 0.29, [β=-0.13, p=4.47×10(-9)] between FOXA2 and SSTR4 was identified to be associated with 25(OH)D levels. Another suggestive association signal at rs11586313 (MAF 0.54) [β=0.90; p=1.36×10(-6)] was found within the regulatory region of the IVL gene on chromosome 1q21.3. Additionally, our study replicated 3 of 5 known GWAS genes associated with 25(OH)D concentrations including GC (p=0.007) and CYP2R1 (p=0.019) reported in Europeans and the DAB1 (p=0.003), reported in Hispanics. Identification of novel association signals in biologically plausible regions with 25(OH)D metabolism will provide new molecular insights on genetic drivers of vitamin D status and its implications in health disparities.
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Affiliation(s)
- Bishwa R Sapkota
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ruth Hopkins
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrew Bjonnes
- Broad Institute of Massachusetts Institute of Technology and Harvard, Massachusetts General Hospital, Cambridge, MA, USA
| | | | | | - Narinder K Mehra
- All India Institute of Medical Sciences and Research, New Delhi, India
| | - Jai Rup Singh
- Central University of Punjab, Bathinda, Punjab, India
| | - Piers R Blackett
- Department of Pediatrics, Section of Endocrinology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Richa Saxena
- Broad Institute of Massachusetts Institute of Technology and Harvard, Massachusetts General Hospital, Cambridge, MA, USA
| | - Dharambir K Sanghera
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Gong J, Tang M, Guo B, Shang J, Tang Y, Xu H. Sex- and age-related differences in femoral neck cross-sectional structural changes in mainland Chinese men and women measured using dual-energy X-ray absorptiometry. Bone 2016; 83:58-64. [PMID: 26475501 DOI: 10.1016/j.bone.2015.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/05/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022]
Abstract
We investigated age-related changes in estimated bone strength and cross-sectional structure of the femoral neck (FN) in mainland Chinese men and women (according to age and sex) using dual-energy X-ray absorptiometry (DXA). A total of 3855 healthy adults (2713 women, 1142 men; ages 25-91years) were analyzed by FN bone mineral density (BMD) assessment and hip structural/strength analysis (HSA), including cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), section modulus (Z), periosteal diameter (PD), endocortical diameter (ED), and cortical thickness (CT) using DXA. HSA differences between age and sex groups were adjusted for body weight, height and FN BMD. Trends according to age were estimated by linear regression analysis. There was no inverse correlation between HSA parameters and age in young adults. Some HSA parameters (CSMI, CSA, Z, CT) decreased significantly with age, whereas PD and ED increased significantly. Older adults had less estimated bone strength and CT and higher PD and ED (p<0.05) than young adults. Men had greater increases in PD and ED than women across all ages. FN strength decreases with age in both sexes, caused by FN cross-sectional structural deterioration. Indirect comparison of our data with those from other populations showed less age-related FN periosteal apposition in Chinese than Caucasian men, but similar amounts in women. This may partly explain different male/female hip fracture rates among ethnic groups. Chinese men have more structural disadvantages regarding FN geometry during aging than Caucasian men, possibly conferring added susceptibility to hip fracture.
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Affiliation(s)
- Jian Gong
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Min Tang
- Department of Ophthalmology, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - JingJie Shang
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yongjin Tang
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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Abstract
UNLABELLED Low vitamin D status is associated with low bone mass which, in turn, is an important predictor of fracture. However, data on this relationship in non-Caucasian populations are scarce. This review shows such an association in the Chinese population in five of the 11 included studies. INTRODUCTION In the elderly population, the serum 25-hydroxyvitamin D [25(OH)D] concentration is often inadequate. This may cause a lower bone mineral density (BMD), which is an important predictor of fracture. It is estimated that by 2050 more than half of all hip fractures worldwide will occur in Asia. However, data on the relationship between vitamin D status and BMD in a non-Caucasian population are scarce. Therefore, this study reviews the literature on the relationship between serum 25(OH)D and BMD in the Chinese population. METHODS A search was made in PubMed, EMBASE, Web of Science and Cochrane Library (up to December 2014) to identify relevant studies using the terms vitamin D status, bone mineral density, and Chinese. RESULTS Of the 293 studies identified, 11 fulfilled the inclusion and exclusion criteria and were analyzed. Mean serum 25(OH)D concentrations ranged from 29-82 nmol/L. In 5 of the 11 studies, an association was found between vitamin D status and BMD in the Chinese population. CONCLUSION The evidence for a relationship between the serum 25(OH)D concentration and BMD in the middle-aged and elderly Chinese population living in Asia appears to be limited and inconsistent.
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Zhen D, Liu L, Guan C, Zhao N, Tang X. High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors. Bone 2015; 71:1-6. [PMID: 25284157 DOI: 10.1016/j.bone.2014.09.024] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Vitamin D deficiency has reached epidemic proportions; this deficiency has been associated with osteoporosis and certain lifestyle factors in adults. This relationship is not well documented among the Lanzhou population in northwest China. This study sought to determine the prevalence of vitamin D deficiency and its risk factors in addition to its relationship with osteoporosis in a Chinese population living in Lanzhou. METHODS This cross-sectional study involved 2942 men and 7158 women aged 40-75years who were randomly selected from 3 communities in the Lanzhou urban district and examined medically. Levels of 25-hydroxy-vitamin D [25(OH)D] and other parameters were measured according to detailed inclusion criteria. Vitamin D deficiency was defined as serum 25(OH)D levels below 20ng/mL. Calcaneus bone mineral density (BMD) was measured by quantitative ultrasound (QUS). RESULTS The prevalence of vitamin D deficiency (25(OH)D levels <20ng/mL) was present in 75.2% of the entire study population. Vitamin D deficiency was more prevalent in women (79.7%) than in men (64%; P<0.001). Multiple logistic regression analysis revealed that the significant predictors of vitamin D deficiency included coronary heart disease (CHD), obesity, dyslipidemia, older age, female sex, and smoking (all P<0.05), whereas tea intake, moderate physical activity, milk intake, vitamin D supplementation and sun exposure were protective (all P<0.05). No significant difference in calcaneus BMD measured by QUS was noted between subjects with <20ng/mL and ≥20ng/mL vitamin D levels (0.53±0.13 vs. 0.54±0.13; P=0.089). The risk of having osteoporosis did not increase when vitamin D levels decreased from ≥20ng/mL to <20ng/mL after multiple adjustments (OR=1.00; 95% CI 0.85-1.16; P=0.357). CONCLUSIONS Vitamin D deficiency is prevalent in the middle-aged and elderly northwestern Chinese population and is largely attributed to CHD, obesity, dyslipidemia, older age, female sex, and smoking. Reduced 25(OH)D levels are not associated with an increased osteoporosis risk.
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Affiliation(s)
- Donghu Zhen
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China.
| | - Lijuan Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China.
| | - Conghui Guan
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China.
| | - Nan Zhao
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China.
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China.
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Ma H, Lin H, Hu Y, Li X, He W, Jin X, Gao J, Zhao N, Liu Z, Gao X. Serum 25-hydroxyvitamin D levels are associated with carotid atherosclerosis in normotensive and euglycemic Chinese postmenopausal women: the Shanghai Changfeng study. BMC Cardiovasc Disord 2014; 14:197. [PMID: 25528383 PMCID: PMC4289590 DOI: 10.1186/1471-2261-14-197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/16/2014] [Indexed: 12/03/2022] Open
Abstract
Background The role of serum 25-hydroxyvitamin D (25 (OH) D) in atherogenesis is unclear. We investigated whether the 25 (OH) D is independently associated with the carotid intima–media thickness (CIMT) and carotid plaques in normotensive and euglycemic postmenopausal women. Methods A total of 671 normotensive and euglycemic postmenopausal women (mean age, 58.8 years) were enrolled from the Changfeng Study. A standard interview, anthropometrics measurements and laboratory analyses were performed for each participant. Bilateral CIMTs were measured using ultrasonography, and the presence of carotid plaques was assessed. The serum 25 (OH) D was measured using electrochemiluminescence immunoassay. Results Serum 25 (OH) D was 43.6 ± 18.2 nmol/L in the postmenopausal women. Compared with subjects with 25 (OH) D in the first, second and third quartiles, subjects with 25 (OH) D in the fourth quartile had decreased CIMT and prevalence of carotid plaque (0.684 ± 0.009 mm vs 0.719 ± 0.009 mm, 0.708 ± 0.009 mm and 0.709 ± 0.009 mm; 10.8% vs 19.0%, 14.8% and 16.8%, respectively). After adjusting for conventional CVD risk factors, PTH, liver and renal function, postmenopausal women with 25 (OH) D in the fourth quartile still had lower CIMT than those in the first, second and third quartiles (p = 0.039) and the subjects in the fourth quartile had a 0.421-fold decreased risk of carotid plaques relative to those in the lowest quartile (95% confidence interval 0.209 to 0.848). Conclusions These results suggest serum 25 (OH) D is independently and inversely associated with carotid atherosclerosis in postmenopausal women with normal blood pressure and normal glucose tolerance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xin Gao
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai 200032, China.
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Risk factors of low vitamin D status in adolescent females in Kuwait: implications for high peak bone mass attainment. Arch Osteoporos 2014; 9:178. [PMID: 24858401 DOI: 10.1007/s11657-014-0178-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 04/07/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Risks of low vitamin D status in Kuwaiti adolescent girls are high parathyroid hormone (PTH), high waist/hip ratio, veiling and not having a private room. Low vitamin D status is likely to have a negative impact on their bone mass and accrual. INTRODUCTION Low serum 25-hydroxyvitamin D (25OHD) levels are repeatedly found in females in the Middle East, which is a cause for concern particularly for adolescent females. This is because vitamin D has been shown to promote bone mineral accrual in adolescence. PURPOSE The aim of this study was to assess the risk factors of low vitamin D status in adolescent females and to assess its impact on their bone mass. METHODS Serum 25OHD and PTH were measured in 232 females. Anthropometric measurements and skin colour were obtained. Bone measurements at the lumbar spine were performed using dual-energy x-ray absorptiometry (DXA). Data on food intake, physical activity (PA) and sun exposure were taken. Binary logistic regression was used to assess the risk factors of serum 25OHD levels <25 nmol/L and multiple linear regression was used to assess the predictors of bone mineral variables. RESULTS Median 25OHD was 19.4 nmol/L (IQR 16.4-23.68), among which 98.7 % obtained <50 nmol/L. PTH >7 pmol/L (odds ratio (OR) 4.3; 95 % CI 1.8, 10.2), not having a private room (OR 3.7; 95 % CI 1.4, 9.8), veiling (OR 2.4; 95 % CI 1.1, 5.5) and waist/hip ratio >0.75 (OR 2.1; 95 % CI 1.0, 4.3) were risk factors of low vitamin D status, whereas, height, weight, month since menarche, PTH, animal protein intake and PA were independent predictors of bone mineral content (p < 0.05). CONCLUSION Low vitamin D status is prevalent in Kuwaiti adolescent females, which may have a negative impact on their bone mineralization and accrual. Further investigation is needed to reveal the underlying causes.
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Abstract
The prevalence of osteoporosis and the incidence of age-related fragility fracture vary by ethnicity. There is greater than 10-fold variation in fracture probabilities between countries across the world. Mineral and bone metabolism are intimately interlinked, and both are known to exhibit patterns of daily variation, known as the diurnal rhythm (DR). Ethnic differences are described for Ca and P metabolism. The importance of these differences is described in detail between select ethnic groups, within the USA between African-Americans and White-Americans, between the Gambia and the UK and between China and the UK. Dietary Ca intake is higher in White-Americans compared with African-Americans, and is higher in White-British compared with Gambian and Chinese adults. Differences are observed also for plasma 25-hydroxy vitamin D, related to lifestyle differences, skin pigmentation and skin exposure to UVB-containing sunshine. Higher plasma 1,25-dihydroxy vitamin D and parathyroid hormone are observed in African-American compared with White-American adults. Plasma parathyroid hormone is also higher in Gambian adults and, in winter, in Chinese compared with White-British adults. There may be ethnic differences in the bone resorptive effects of parathyroid hormone, with a relative skeletal resistance to parathyroid hormone observed in some, but not all ethnic groups. Renal mineral excretion is also influenced by ethnicity; urinary Ca (uCa) and urinary P (uP) excretions are lower in African-Americans compared with White-Americans, and in Gambians compared with their White-British counterparts. Little is known about ethnic differences in the DR of Ca and P metabolism, but differences may be expected due to known differences in lifestyle factors, such as dietary intake and sleep/wake pattern. The ethnic-specific DR of Ca and P metabolism may influence the net balance of Ca and P conservation and bone remodelling. These ethnic differences in Ca, P and the bone metabolism may be important factors in the variation in skeletal health.
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Affiliation(s)
- J. Redmond
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, Cambridge CB1 9NL, UK
| | | | - B. Zhou
- Department of Public health, Shenyang Medical College, 146 Huanghe North Street, Shenyang 110034, People's Republic of China
| | - A. Prentice
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, Cambridge CB1 9NL, UK
- Medical Research Council Keneba, The Gambia
| | - I. Schoenmakers
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, Cambridge CB1 9NL, UK
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Ginter JK, Krithika S, Gozdzik A, Hanwell H, Whiting S, Parra EJ. Vitamin D status of older adults of diverse ancestry living in the Greater Toronto Area. BMC Geriatr 2013; 13:66. [PMID: 23815187 PMCID: PMC3721999 DOI: 10.1186/1471-2318-13-66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/12/2013] [Indexed: 11/11/2022] Open
Abstract
Background Physiological and lifestyle factors put older adults at an increased risk of vitamin D insufficiency and resulting negative health outcomes. Here we explore the vitamin D status in a sample of community dwelling older adults of diverse ancestry living in the Greater Toronto area (GTA). Methods Two hundred and twenty-four (224) adults over 60 years of age were recruited from the Square One Older Adult Centre, in Mississauga, Ontario. Circulating 25-hydroxyvitamin D (25(OH)D) concentrations were measured from dried blood spot cards. Dietary and supplemental intakes of vitamin D were assessed via questionnaires. Skin pigmentation was assessed quantitatively by measuring melanin levels using a reflectometer. Results The mean 25(OH)D concentration in the total sample was 82.4 nmol/L. There were no statistically significant differences in serum 25(OH)D concentrations, supplemental or dietary vitamin D intakes between the three major ancestral groups (East Asians, Europeans and South Asians). Females had significantly higher 25(OH)D concentrations than males (84.5 nmol/L vs. 72.2 nmol/L, p = 0.012). The proportion of participants with 25(OH)D concentrations below 50 nmol/L and 75 nmol/L were 12.1%, and 38.8%, respectively. The mean daily supplemental intake of vitamin D was 917 IU/day. Vitamin D intake from supplements was the major factor determining 25(OH)D concentrations (p < 0.001). Conclusions Mean concentration of 25(OH)D in a sample of older adults of diverse ancestry living in the GTA exceeded 80 nmol/L, and there were no significant differences in 25(OH)D levels between ancestral groups. These results sharply contrast with our recent study focused on young adults of diverse ancestry living in the same geographic area, in which we found substantially lower 25(OH)D concentrations (mean 39.5 nmol/L), low supplemental vitamin D intake (114 IU/day), and significant differences in 25(OH)D levels between ancestral groups. High daily intake of supplemental vitamin D in this sample of older adults likely accounts for such disparate findings with respect to the young adult sample.
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Zhang W, Stoecklin E, Eggersdorfer M. A glimpse of vitamin D status in Mainland China. Nutrition 2013; 29:953-7. [PMID: 23594582 DOI: 10.1016/j.nut.2013.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/07/2013] [Accepted: 01/11/2013] [Indexed: 12/27/2022]
Abstract
As an essential dietary micronutrient, vitamin D plays a pivotal role in promoting calcium absorption in the intestine and maintaining a healthy skeletal system throughout life. Beyond bone health, an emerging volume of scientific studies shows that vitamin D also may provide cardiovascular, metabolic, and immunologic benefits and reduce mortality. To our knowledge, in mainland China no national surveys have been conducted to date to depict the overall vitamin D status in the population. Therefore, the purpose of this contribution was to provide the best possible evaluation of vitamin D deficiency/insufficiency in China by reviewing publications that measured plasma/serum 25-hydroxyvitamin-D (25[OH]D) levels in various age groups and in different areas of China from January 2000 to June 2012. From these investigations conducted throughout the country and from newborns to adults to the elderly, it has been found that vitamin D deficiency/insufficiency is prevalent in the Chinese population in almost all age groups and areas if individuals are not taking vitamin D-fortified products/supplements or are lacking sufficient sunshine exposure. Some studies showed severe deficiency (25[OH]D <25 nmol/L) in Nanjing (north latitude 31) during the winter months and in Beijing (north latitude 40) in the fall. This unoptimistic situation represents a significant but modifiable public health risk that deserves greater attention and more efficient and timely management.
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Affiliation(s)
- Weiguo Zhang
- DSM Nutritional Products, Human Nutrition and Health, Beijing, China and Kaiseraugst, Switzerland.
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Ardawi MSM, Qari MH, Rouzi AA, Maimani AA, Raddadi RM. Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women. Osteoporos Int 2011; 22:463-75. [PMID: 20431993 DOI: 10.1007/s00198-010-1249-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 03/22/2010] [Indexed: 11/29/2022]
Abstract
UNLABELLED The various factors that may contribute to vitamin D deficiency or insufficiency were examined among healthy Saudi pre- and postmenopausal women. Vitamin D deficiency was highly prevalent among studied Saudi women with obesity, poor sunlight exposure, poor dietary vitamin D supplementation and age as the main risk factors. INTRODUCTION The various factors that may contribute to vitamin D deficiency or insufficiency in relation to bone health among Saudi women are not known. The main objectives of the present study were to determine the factors influencing vitamin D status in relation to serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (PTH), bone turnover markers (BTMs), bone mineral density (BMD), and vitamin D receptor genotype (VDR) in healthy Saudi pre- and postmenopausal women. METHODS A total number of 1,172 healthy Saudi women living in the Jeddah area were randomly selected and studied. Anthropometric parameters, socioeconomic status, sun exposure index together with serum levels of 25(OH)D, calcitriol, intact PTH, Ca, PO4, Mg, creatinine, albumin, and biochemical BTMs were measured. BMD was measured by a dual energy X-ray absorptiometry and VDR genotypes were also determined. RESULTS About 80.0% of Saudi women studied exhibited vitamin D deficiency (serum 25(OH)D<50.0 nmol/L) with only 11.8% of all women were considered with adequate vitamin D status (serum 25(OH)D>75 nmol/L). Secondary hyperparathyroidism was evident in 18.5% and 24.6% in pre- and postmenopausal women with 25(OH)D<50 nmol/L. Serum 25(OH)D was lower (P<0.001) and intact PTH higher (P<0.001) in the upper quintiles of body mass index (BMI) and waist-to-hip ratio (WHR). Multiple linear regression analysis showed that BMI, sun exposure index, poor dietary vitamin D supplementation, WHR, and age were independent positive predictors of serum 25(OH)D values. CONCLUSIONS Vitamin D deficiency is highly prevalent among healthy Saudi pre-and postmenopausal women and largely attributed to obesity, poor exposure to sunlight, poor dietary vitamin D supplementation, and age.
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Affiliation(s)
- M-S M Ardawi
- Center of Excellence for Osteoporosis Research, King Abdulaziz University, P.O. Box No. 20724, Jeddah, 21465, Saudi Arabia.
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Arabi A, Baddoura R, El-Rassi R, El-Hajj Fuleihan G. Age but not gender modulates the relationship between PTH and vitamin D. Bone 2010; 47:408-12. [PMID: 20452474 DOI: 10.1016/j.bone.2010.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/19/2010] [Accepted: 05/01/2010] [Indexed: 10/19/2022]
Abstract
CONTEXT It is unclear whether the relationship between 25-OHD and PTH is modulated by age or gender. OBJECTIVE To assess the 25-OHD-PTH relationship in 340 adolescents (10-17 years) and 443 elderly (65-85 years) of the same ethnic group, and living in the same sunny country. ASSESSMENTS Calcium intake was estimated. Serum calcium, phosphorus, 25-OHD and PTH were measured. Body fat was determined by DXA. RESULTS 25-OHD levels were lower in the elderly in the overall group (p<0.001) and within genders. 25-OHD levels were lower in females in the overall group and within age subgroups (p<0.05). PTH levels were higher in the elderly in the overall population and in both genders (p<0.001). There were no gender differences in PTH levels within age subgroups. For the same 25-OHD level, PTH levels were comparable across genders but were 1.5-2 folds higher in the elderly compared to adolescents (p<0.001). PTH correlated positively with age (p<0.001), body fat (p=0.02), and negatively with calcium intake (p<0.001), and 25-OHD (p<0.001). The magnitude of the correlation with 25-OHD decreased after adjustment for age but not for gender. In multivariate analyses, age, 25-OHD and fat mass were independent predictors for PTH. In the elderly, after adjustment for serum creatinine, only 25-OHD and creatinine were independent predictors of PTH. CONCLUSION The negative relationship between 25-OHD and PTH is modulated by age but not gender. Desirable 25-OHD levels derived from examining the 25-OHD-PTH relationship should therefore take into account the age of the population of interest.
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Affiliation(s)
- Asma Arabi
- Calcium Metabolism and Osteoporosis Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Ensrud KE, Taylor BC, Paudel ML, Cauley JA, Cawthon PM, Cummings SR, Fink HA, Barrett-Connor E, Zmuda JM, Shikany JM, Orwoll ES. Serum 25-hydroxyvitamin D levels and rate of hip bone loss in older men. J Clin Endocrinol Metab 2009; 94:2773-80. [PMID: 19454586 PMCID: PMC2730873 DOI: 10.1210/jc.2008-2786] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Vitamin D deficiency is common among older adults, but the association between 25-hydroxyvitamin D [25(OH)D] levels and rates of bone loss is uncertain. OBJECTIVE Our aim was to test the hypothesis that lower 25(OH)D levels are associated with higher rates of hip bone loss in older men. DESIGN AND SETTING We conducted a prospective cohort study in six U.S. centers. PARTICIPANTS A total of 1279 community-dwelling men aged 65 yr or older with 25(OH)D levels (liquid chromatography-tandem mass spectroscopy) and hip bone mineral density (BMD) (dual-energy x-ray absorptiometry) at baseline and repeat hip BMD an average of 4.4 yr later participated in the study. MAIN OUTCOME MEASURE(S) We measured the annualized percentage rate of change in hip BMD. RESULTS After adjustment for multiple potential confounders, the average rate of decline in total hip BMD was -0.59%/yr among men with 25(OH)D levels below 15.0 ng/ml, -0.54%/yr among men with 25(OH)D levels 15.0-19.9 ng/ml, -0.35%/yr among men with 25(OH)D levels 20.0-29.9 ng/ml, and -0.37%/yr among men with 25(OH)D levels of at least 30 ng/ml (P trend = 0.008 for multivariable model). Evidence was strong to support an association among men aged 75 yr and older (P trend <0.001), but not among younger men (P trend = 0.55). Findings were similar when 25(OH)D level was expressed in quintiles and when BMD at hip subregions was substituted for total hip BMD. CONCLUSIONS In this cohort of community-dwelling older men, men with 25(OH)D levels below 20 ng/ml had greater subsequent rates of hip bone loss, but rates of loss were similar among men with higher levels. These results lend support to the view that low 25(OH)D levels are detrimental to BMD in older men.
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Affiliation(s)
- Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, VA Medical Center, One Veterans Drive (111-0), Minneapolis, MN 55417, USA.
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Yan L, Schoenmakers I, Zhou B, Jarjou LM, Smith E, Nigdikar S, Goldberg GR, Prentice A. Ethnic differences in parathyroid hormone secretion and mineral metabolism in response to oral phosphate administration. Bone 2009; 45:238-45. [PMID: 19394454 PMCID: PMC2764389 DOI: 10.1016/j.bone.2009.04.237] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 01/30/2009] [Accepted: 04/20/2009] [Indexed: 11/26/2022]
Abstract
Ethnic differences in bone metabolism have been reported and it has been suggested that these may be partly due to prolonged exposure to an elevated plasma parathyroid hormone (PTH) concentration or a decreased sensitivity to PTH. We explored ethnic differences in bone and mineral metabolism by 5 days of oral phosphate (P) loading to stimulate PTH secretion. Healthy older people from UK (B), The Gambia (G) and China (C), 15 individuals from each sex and ethnic group, were studied. Blood and urine samples were collected before and 2 h after P dose on days 1, 4 and 5 and on a control day. The induced changes (%) in PTH and markers of mineral and bone metabolism after 2 h and over 5 days were examined. At baseline, PTH, 1,25(OH)(2)D and bone turnover markers were higher in Gambian subjects than in British and Chinese subjects (P < or = 0.01). 2 h after P loading, ionized calcium (iCa) decreased and PTH and plasma P (P) increased in all groups (P < or = 0.01, n.s. between groups). Urinary P to creatinine ratio (uP/Cr) increased, the increase being greater in Chinese subjects than in British and Gambian subjects on days 4 and 5 (P < or = 0.01). By day 5, fasting iCa was decreased and P increased in British and Gambian (P < or = 0.01) but not in Chinese subjects. Fasting PTH and uP/Cr increased in all groups. There were ethnic differences in changes in bone markers, but the relationship with changes in PTH was comparable between groups. In conclusion, ethnic differences in mineral metabolism in response to 5-day P loading were found. Chinese subjects showed a more rapid renal clearance of P than British and Gambian counterparts and there were differences between the groups in the skeletal response to P loading, but no evidence was found for resistance to the resorbing effects of PTH.
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Affiliation(s)
- Liya Yan
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
| | - Inez Schoenmakers
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
| | - Bo Zhou
- Department of Preventive Medicine, Shenyang Medical College, 146 Huanghe North Street, Shenyang 110034, PR China
| | | | - Emily Smith
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
| | - Shailja Nigdikar
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
| | - Gail R. Goldberg
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
- MRC Keneba, Gambia
| | - Ann Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
- MRC Keneba, Gambia
- Corresponding author. MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK. Fax: +44 1223 437515.
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Lu L, Yu Z, Pan A, Hu FB, Franco OH, Li H, Li X, Yang X, Chen Y, Lin X. Plasma 25-hydroxyvitamin D concentration and metabolic syndrome among middle-aged and elderly Chinese individuals. Diabetes Care 2009; 32:1278-83. [PMID: 19366976 PMCID: PMC2699709 DOI: 10.2337/dc09-0209] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the association between 25-hydroxyvitamin D [25(OH)D] and metabolic syndrome in the Chinese population. RESEARCH DESIGN AND METHODS Plasma 25(OH)D was measured in a cross-sectional sample of 1,443 men and 1,819 women aged 50-70 years from Beijing and Shanghai. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. Fasting plasma glucose, insulin, lipid profile, A1C, and inflammatory markers were measured. RESULTS The geometric mean of plasma 25(OH)D was 40.4 nmol/l, and percentages of vitamin D deficiency [25(OH)D <50 nmol/l] and insufficiency [50 <or= 25(OH)D <75 nmol/l] were 69.2 and 24.4%, respectively. Compared with the highest 25(OH)D quintile (>or=57.7 nmol/l), the odds ratio for metabolic syndrome in the lowest quintile (<or=28.7 nmol/l) was 1.52 (95% CI 1.17-1.98, P(trend) = 0.0002) after multiple adjustment. Significant inverse associations also existed between 25(OH)D and individual metabolic syndrome components plus A1C. Moreover, we observed significant inverse associations of 25(OH)D with fasting insulin and the insulin resistance index (homeostasis model assessment of insulin resistance [HOMA-IR]) in overweight and obese individuals (BMI >or=24 kg/m(2)) but not in their normal-weight counterparts (test for interaction: P = 0.0363 and 0.0187 for insulin and HOMA-IR, respectively). CONCLUSIONS Vitamin D deficiency is common in the middle-aged and elderly Chinese population, and a low 25(OH)D level is significantly associated with an increased risk of having metabolic syndrome and insulin resistance. Prospective studies and randomized clinical trials are warranted to determine the role of 25(OH)D in the development of metabolic syndrome and related metabolic diseases.
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Affiliation(s)
- Ling Lu
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Graduate School of the Chinese Academy of Sciences, Shanghai, China
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25
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Tomida K, Hamano T, Mikami S, Fujii N, Okada N, Matsui I, Nagasawa Y, Moriyama T, Ito T, Imai E, Isaka Y, Rakugi H. Serum 25-hydroxyvitamin D as an independent determinant of 1-84 PTH and bone mineral density in non-diabetic predialysis CKD patients. Bone 2009; 44:678-83. [PMID: 19111635 DOI: 10.1016/j.bone.2008.11.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 11/15/2008] [Accepted: 11/20/2008] [Indexed: 11/19/2022]
Abstract
The role of 25-hydroxyvitamin D [25(OH)D] and fibroblast growth factor-23 (FGF-23) in chronic kidney disease-mineral and bone disorder (CKD-MBD) remains elusive in predialysis CKD patients. From the fact that FGF-23 suppresses bone mineralization in vitro and that 1alpha-hydroxylase is present in parathyroid cells and osteoblasts, they may be associated with bone mass or serum parathyroid hormone (PTH) level. In this cross-sectional observational study, we investigated the potential associations of 25(OH)D or FGF-23 with 1-84 PTH and bone mineral density (BMD) in the femoral neck (FN) and lumbar spine (LS) of 325 non-diabetic patients. All patients had stages 3-5 CKD and had never been treated with bisphosphonate, estrogen, or vitamin D. We measured bone-specific alkaline phosphatase (bone ALP), intact FGF-23 and 1-84 PTH in a third generation assay, and performed a multiple regression analysis for 1-84 PTH and BMD Z-score. In our cohort, 80.1% had 25(OH)D levels less than 30 ng/mL, and 4.1% had levels less than 15 ng/mL. A univariate analysis indicated a negative association for 25(OH)D with 1-84 PTH and bone ALP. A multivariate analysis showed that the significant determinants for 1-84 PTH were 25(OH)D, estimated glomerular filtration rate (eGFR), corrected calcium, serum calcitriol and phosphate. Intriguingly, the three former parameters had negative associations with 1-84 PTH while calcitriol had a positive association. While further adjustment of FGF-23 extinguished the positive association of phosphate and 1-84 PTH, there was absolutely no increase in the R2. With regard to the BMD Z-score, 25(OH)D and the body mass index were the significant common independent positive determinants for both FN and LS, whereas bone ALP was the negative determinant even though there was no correlation noted for 1-84 PTH, calcitriol, or FGF-23 with BMD. In addition, eGFR positively contributed to the Z-score only in FN. Therefore, despite a positive correlation between 25(OH)D and calcitriol, their contribution to the CKD-MBD appears to be different. Since the significant associations for 25(OH)D with 1-84 PTH and BMD were independent of serum calcitriol and bone ALP, this might imply that 25(OH)D has a direct effect on the parathyroid gland and bone.
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Affiliation(s)
- Kodo Tomida
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Box B6, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
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26
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Abstract
The prevalence of clinical vitamin D deficiency (rickets and osteomalacia) is high in many parts of the world, and there is a resurgence of rickets among children of ethnic minority groups in Europe and Australasia. Plasma 25-hydroxyvitamin D concentration (25OHD) is a useful risk marker of clinical vitamin D deficiency. This review summarizes the factors that contribute to differences in 25OHD among populations and provides an overview of the prevalence of low vitamin D status worldwide. It discusses the controversies that surround the interpretation of 25OHD, other proposed indices of vitamin D adequacy and dietary reference values for vitamin D, and describes the emerging evidence that a very low calcium intake may contribute to the etiology of rickets in Africa and Asia. There is an urgent need for action to address the global burden of rickets and osteomalacia.
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Affiliation(s)
- Ann Prentice
- The Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom and Medical Research Council Keneba, Keneba, The Gambia.
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Prentice A, Goldberg GR, Schoenmakers I. Vitamin D across the lifecycle: physiology and biomarkers. Am J Clin Nutr 2008; 88:500S-506S. [PMID: 18689390 DOI: 10.1093/ajcn/88.2.500s] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The field of vitamin D public health research has a pressing need to define sensitive and specific predictors of vitamin D status that can be used to determine whether an individual or population has a supply of vitamin D that is sufficient to meet requirements. The aim of this review is to highlight the considerations needed when evaluating evidence of the relations between vitamin D biomarkers and functional or health outcomes across the life cycle. It draws attention to the importance of distinguishing between biomarkers of supply, function, and outcome and of considering the many factors that could influence interpretation, such as life stage, ethnicity, body mass index, liver and kidney function, and dietary calcium and phosphorus intake. The vitamin D biomarkers that have shown the most utility to date are the plasma concentration of 25-hydroxyvitamin D (supply), the plasma concentration of parathyroid hormone (function), and the presence or absence of rickets (outcome). However, a single biomarker of vitamin D status or threshold value is unlikely to be valid in all situations. The field therefore needs research to refine existing biomarkers or establish new indicators that take the many factors into account and to identify useful functional biomarkers of vitamin D status for infants, children, women of reproductive age, and specific ethnic groups. However, evidence using the biomarkers currently available shows that frank vitamin D deficiency is a major public health problem in many parts of the world that requires urgent attention.
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Affiliation(s)
- Ann Prentice
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom.
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28
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Very high rates of vitamin D insufficiency in women of child-bearing age living in Beijing and Hong Kong. Br J Nutr 2008; 99:1330-4. [DOI: 10.1017/s0007114507844382] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We aimed to describe the vitamin D status of young women living in two Chinese cities in the spring – Beijing in the north (latitude 39° north) and Hong Kong (latitude 22° north) in the south. We also examined the relationship between serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations to determine a threshold for serum 25-hydroxyvitamin D above which there is no further suppression of PTH. Finally, we examined whether dietary Ca intake influences this relationship. Non-pregnant women aged 18–40 years (n 441) were recruited between February and June. Fasting blood was collected and dietary intakes were assessed using 5 d food records. Mean serum 25-hydroxyvitamin D concentration was lower in Beijing than Hong Kong women (29 v. 34 nmol/l; P < 0·001). Vitamin D deficiency ( ≤ 25 nmol/l) was indicated in 40 % of Beijing and 18 % of Hong Kong women, and over 90 % of women in both cities were insufficient ( ≤ 50 nmol/l). Mean Ca and vitamin D intakes were 478 mg/d and 2·0 μg/d, respectively. The relationship between 25-hydroxyvitamin D concentration and PTH was linear throughout the range with a slope of − 0·36 (different from 0; P < 0·001; R 0·26), with no apparent threshold. There was no influence of Ca intake on the relationship between 25-hydroxyvitamin D and PTH concentration. Vitamin D deficiency is common and insufficiency is very common in non-pregnant women in Hong Kong and Beijing during spring. Serum 25-hydroxyvitamin D was inversely associated with PTH with no apparent threshold. Strategies such as vitamin D fortification or supplementation may be required.
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29
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Nakamura K, Tsugawa N, Saito T, Ishikawa M, Tsuchiya Y, Hyodo K, Maruyama K, Oshiki R, Kobayashi R, Nashimoto M, Yoshihara A, Ozaki R, Okano T, Yamamoto M. Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi Study. Bone 2008; 42:271-7. [PMID: 18006400 DOI: 10.1016/j.bone.2007.09.056] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 07/27/2007] [Accepted: 09/28/2007] [Indexed: 11/18/2022]
Abstract
Little has been understood about vitamin D status in relation to bone health in Asian women. The purpose of this study was to identify how the serum 25-hydroxyvitamin D (25[OH]D) concentration is associated with bone mass and bone metabolism. This cross-sectional, community-based epidemiologic study was conducted among 600 ambulatory postmenopausal women. The serum 25(OH)D concentration was measured with radioimmunoassay. Other blood biochemical measurements were intact parathyroid hormone and markers of bone turnover, including osteocalcin and type I collagen cross-linked N-telopeptides. Bone mineral density (BMD) of the lumbar spine and right femoral neck were measured with the dual-energy X-ray absorptiometry method using a QDR4500a. The mean serum 25(OH)D concentration was 55.6 nmol/L (SD 14.6). Serum 25(OH)D concentration was linearly associated with BMD of the femoral neck (R(2)=0.020, P=0.003), but not with BMD of the lumbar spine. Odds ratios (ORs) for low BMD (defined as t score < or =-2.5 SD) were calculated for strata defined by 25(OH)D concentration. The prevalence of low BMD of the lumbar spine was significantly higher in the 40- to 50-nmol/L 25(OH)D group (adjusted OR=3.0, 95% CI: 1.3-7.0) compared to the reference group (> or =70 nmol/L). Prevalence of low BMD for the femoral neck was significantly higher in the 30- to 40-nmol/L (adjusted OR=3.6, 95% CI: 1.1-12.1) and the 40- to 50-nmol/L (adjusted OR=7.6, 95% CI: 2.5-23.2) groups compared to the reference group (> or =70 nmol/L). The mean serum concentration of intact PTH was significantly higher in subjects with serum 25(OH)D <50 nmol/L compared to those with serum 25(OH)D > or =50 nmol/L. The present study suggests that higher serum 25(OH)D concentrations are associated with increased BMD of the femoral neck, and that a serum 25(OH)D concentration of at least 70 nmol/L is needed to obtain high BMD of the femoral neck, and that of at least 50 nmol/L is needed to achieve normal PTH levels and prevent low BMD in home-dwelling postmenopausal Japanese women.
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Affiliation(s)
- Kazutoshi Nakamura
- Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
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30
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31
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Abstract
2006 marked the centenary of the birth of Dr Elsie Widdowson, a pioneer of nutrition science. One of the hallmarks of Elsie Widdowson's research was an integrative approach that recognised the importance of investigating the mechanisms underpinning a public health or clinical issue at all levels, looking into the physiology, comparative biology, intermediate metabolism and basic science. The theme of the present lecture, given in celebration of the work of Dr Widdowson, is mineral nutrition, with a particular focus on Ca, P and vitamin D. The contributions of Dr Widdowson to the early understanding of mineral nutrition are reviewed and the latest scientific findings in this rapidly-expanding field of research are presented.
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Affiliation(s)
- Ann Prentice
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL and MRC Keneba, The Gambia.
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32
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Zittermann A. Vitamin D and disease prevention with special reference to cardiovascular disease. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2006; 92:39-48. [PMID: 16600341 DOI: 10.1016/j.pbiomolbio.2006.02.001] [Citation(s) in RCA: 275] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Circulating 25-hydroxyvitamin D [25(OH)D] is the hallmark for determining vitamin D status. Serum parathyroid hormone [PTH] increases progressively when 25(OH)D falls below 75 nmol/l. Concentrations of 25(OH)D below 50 nmol/l or even below 25 nmol/l are frequently observed in various population groups throughout the world. This paper highlights the relationship of vitamin D insufficiency with cardiovascular disease and non-insulin dependent diabetes mellitus, two diseases that account for up to 50% of all deaths in western countries. There is evidence from patients with end-stage renal disease that high PTH concentrations are causally related to cardiovascular morbidity and mortality. Activated vitamin D is able to increase survival in this patient group significantly. Moreover, already slightly enhanced PTH concentrations are associated with ventricular hypertrophy and coronary heart disease in the general population. Experimental studies have demonstrated that a lack of vitamin D action leads to hypertension in mice. Some intervention trials have also shown that vitamin D can reduce blood pressure in hypertensive patients. In young and elderly adults, serum 25(OH)D is inversely correlated with blood glucose concentrations and insulin resistance. Sun-deprived lifestyle, resulting in low cutaneous vitamin D synthesis, is the major factor for an insufficient vitamin D status. Unfortunately, vitamin D content of most foods is negligible. Moreover, fortified foods and over-the-counter supplements usually contain inadequate amounts of vitamin D to increase serum 25(OH)D to 75 nmol/l. As a consequence, legislation has to be changed to allow higher amounts of vitamin D in fortified foods and supplements.
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Affiliation(s)
- Armin Zittermann
- Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Georgstrasse 11, 32545, Germany.
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33
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Yan L, Zhou B, Nigdikar S, Wang X, Bennett J, Prentice A. Effect of apolipoprotein E genotype on vitamin K status in healthy older adults from China and the UK. Br J Nutr 2006; 94:956-61. [PMID: 16351773 DOI: 10.1079/bjn20051578] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The vitamin K concentration in the circulation and the availability of vitamin K to bone may be affected by factors influencing lipoprotein metabolism, such as apoE genotype. The relationships between markers of vitamin K status, bone mineral content and apoE genotype were studied in healthy older men and women aged 60-83 years, 177 from Shenyang, China, and 132 from Cambridge, UK. Fasting plasma was analysed for vitamin K1, triacylglycerol, total osteocalcin, undercarboxylated osteocalcin (ucOC) and apoE genotype. Hip bone mineral content was measured using dual-energy X-ray absorptiometry. Subjects were grouped according to apoE genotype as E2/3, E3/3 and [E3/4+E4/4]. The mean plasma vitamin K1 concentration of the three genotype groups was significantly higher and the percentage ucOC was lower in the Chinese than in the British subjects (P<0.01). A higher vitamin K1 concentration was found in subjects with [E3/4+E4/4] than those with either E2/3 or E3/3 in Cambridge (32.2 (SE 14.6 ) %, P=0.03; 24.6 (SE 10.7 ) %, P=0.02). Similar trends were observed although were not statistically significant in Shenyang (26.5 (18.9) %, P=0.16; 23.1 (13.0) %, P=0.08). Subjects with [E3/4+E4/4] had a lower percentage ucOC (total osteocalcin adjusted) than did those with either E2/3 or E3/3 in Shenyang (65.1 (27.2) %, P=0.02; 49.6 (19.9) %, P=0.01 respectively) but not in Cambridge. This study demonstrates that a superior vitamin K status is associated with the apoE4 genotype in healthy older individuals from China and the UK.
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Affiliation(s)
- Liya Yan
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.
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34
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Aspray TJ, Yan L, Prentice A. Parathyroid hormone and rates of bone formation are raised in perimenopausal rural Gambian women. Bone 2005; 36:710-20. [PMID: 15780975 DOI: 10.1016/j.bone.2005.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 12/06/2004] [Accepted: 01/13/2005] [Indexed: 11/28/2022]
Abstract
To investigate rates of bone turnover and calcium homeostasis in Gambian women, we recruited 103 peri- and postmenopausal women, aged 45 to 80+ years and 11 women of reproductive age. Fasting blood was analyzed for plasma osteocalcin, PTH, 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], total- and bone-specific alkaline phosphatase. Plasma and urinary calcium, inorganic phosphate, sodium, potassium, creatinine, and albumin and urine free deoxypyridinoline (Dpd) was also measured. Samples from 20 premenopausal and 31 postmenopausal women from Cambridge, UK were analyzed, using the same methodology for comparison. For the Gambian women, peak calcium excretion occurred at around 50 years of age. For women aged > or =45 years, calcium excretion decreased by 3.0% per year of age (SE 1%; P < 0.005). In this age group, 25(OH)D also decreased with age (P < 0.005). Urinary sodium output, pH, and titratable acid output decreased (all P < 0.05) and total alkaline phosphatase (P < 0.005), osteocalcin (P < 0.005), and PTH (P < 0.05) increased with age. Comparisons were made between the following groups of Gambian and British women: premenopausal, early (age 55-64 years)- and late (age 65+ years)-postmenopausal. Gambian women of all ages were lighter (P < 0.001), shorter (P < 0.01), and had higher plasma bone-specific alkaline phosphatase activity (P < 0.05) and higher concentrations of osteocalcin (P < 0.05), PTH (P < 0.001), 1,25(OH)(2)D (P < 0.001), and 25(OH)D (P < 0.001). There were no consistent differences in calcitonin, while urinary free Dpd outputs were lower in the Gambians (P < 0.001). Plasma calcium, phosphate, and albumin (P < 0.01) were significantly lower. Urinary calcium, phosphate, sodium, and potassium excretion were lower, particularly in the postmenopausal group (P < 0.001). Although Gambian urine pH was more acidic, titratable acid output was lower (P < 0.01). These data show that Gambian women with low dietary calcium intakes and good vitamin D status have low urinary calcium excretion and that menopausal changes in calcium and bone metabolism among Gambian women are similar to those seen in other populations. In addition, they demonstrate that Gambian women of all ages have raised plasma PTH and 1,25(OH)(2)D concentrations and raised markers of osteoblast activity. We postulate that high endogenous PTH concentrations may be beneficial to bone health in Gambian women, removing fatigue damage and improving bone quality.
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Affiliation(s)
- Terence J Aspray
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
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