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Laird E, O'Halloran AM, Molloy AM, Healy M, Bourke N, Kenny RA. Vitamin D status & associations with inflammation in older adults. PLoS One 2023; 18:e0287169. [PMID: 37379302 DOI: 10.1371/journal.pone.0287169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Research studies have observed associations of vitamin D with inflammation but data in representative older adult studies is lacking. We aimed to investigate the association of C-reactive protein (CRP) with vitamin D status in a representative sample of the older Irish population. The concentrations of 25-hydroxyvitamin D (25(OH)D) and CRP was measured in 5,381 community dwelling Irish adults aged ≥50 years from the Irish Longitudinal Study on Ageing (TILDA). Demographic, health and lifestyle variables were assessed by questionnaire and categorical proportions of CRP were generated by vitamin D status and age. Multi-nominal logistic regression was used to investigate the association of 25(OH)D and CRP status. The prevalence (mean; 95% confidence interval (95% CI)) of normal CRP status (0-5 mg/dL) was 83.9% (82.6-85.0%), elevated status (5-10 mg/dL) 11.0% (9.9-12.0%) and high status (>10 mg/dL) was 5.1% (4.5-5.8%). Mean (95% CI) CRP concentrations were lower in those with normal vs. deficient 25(OH)D status (2.02 mg/dL (1.95-2.08) vs. 2.60 mg/dL (2.41-2.82); p<0.0001). In a logistic regression analysis, those with insufficient or sufficient 25(OH)D status were less likely to have a high CRP status compared to those with deficient 25(OH)D status (insufficient: coefficient (CE) -0.732, 95% CI -1.12-0.33, p<0.0001; sufficient: CE -0.599, 95% CI -0.95-0.24, p = 0.001). In conclusion older adults with deficient vitamin D status had higher levels of inflammation as measured by CRP. Given that inflammation is an important pathological driver of chronic diseases of ageing, and that emerging evidence suggests that vitamin D therapy can reduce inflammation in some disease settings, optimising vitamin D status could represent an effective low risk/low-cost pathway to modulate inflammation in community dwelling older adults.
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Affiliation(s)
- Eamon Laird
- School of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Martin Healy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig Bourke
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- The TILDA Study, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Dunlop E, Boorman JL, Hambridge TL, McNeill J, James AP, Kiely M, Nowson CA, Rangan A, Cunningham J, Adorno P, Atyeo P, Black LJ. Evidence of low vitamin D intakes in the Australian population points to a need for data-driven nutrition policy for improving population vitamin D status. J Hum Nutr Diet 2023; 36:203-215. [PMID: 35253289 PMCID: PMC10946753 DOI: 10.1111/jhn.13002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nearly one in four Australian adults is vitamin D deficient (serum 25-hydroxyvitamin D concentrations [25(OH)D] < 50 nmol L-1 ) and current vitamin D intakes in the Australian population are unknown. Internationally, vitamin D intakes are commonly below recommendations, although estimates generally rely on food composition data that do not include 25(OH)D. We aimed to estimate usual vitamin D intakes in the Australian population. METHODS Nationally representative food consumption data were collected for Australians aged ≥ 2 years (n = 12,153) as part of the cross-sectional 2011-2013 Australian Health Survey (AHS). New analytical vitamin D food composition data for vitamin D3 , 25(OH)D3 , vitamin D2 and 25(OH)D2 were mapped to foods and beverages that were commonly consumed by AHS participants. Usual vitamin D intakes (µg day-1 ) by sex and age group were estimated using the National Cancer Institute method. RESULTS Assuming a 25(OH)D bioactivity factor of 1, mean daily intakes of vitamin D ranged between 1.84 and 3.25 µg day-1 . Compared to the estimated average requirement of 10 µg day-1 recommended by the Institute of Medicine, more than 95% of people had inadequate vitamin D intakes. We estimated that no participant exceeded the Institute of Medicine's Upper Level of Intake (63-100 µg day-1 , depending on age group). CONCLUSIONS Usual vitamin D intakes in Australia are low. This evidence, paired with the high prevalence of vitamin D deficiency in Australia, suggests that data-driven nutrition policy is required to safely increase dietary intakes of vitamin D and improve vitamin D status at the population level.
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Affiliation(s)
- Eleanor Dunlop
- Curtin School of Population HealthCurtin UniversityBentleyWAAustralia
| | | | | | | | - Anthony P. James
- Curtin School of Population HealthCurtin UniversityBentleyWAAustralia
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Caryl A. Nowson
- Institute for Physical Activity and Nutrition ResearchDeakin UniversityBurwoodVICAustralia
| | - Anna Rangan
- Charles Perkins CentreThe University of SydneyCamperdownNSWAustralia
| | - Judy Cunningham
- Curtin School of Population HealthCurtin UniversityBentleyWAAustralia
| | - Paul Adorno
- National Measurement InstitutePort MelbourneVICAustralia
| | - Paul Atyeo
- Australian Bureau of StatisticsBelconnenACTAustralia
| | - Lucinda J. Black
- Curtin School of Population HealthCurtin UniversityBentleyWAAustralia
- Curtin Health Innovation Research Institute (CHIRI)Curtin UniversityBentleyWAAustralia
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Selenium intakes in the Irish adult population. J Nutr Sci 2023; 12:e35. [PMID: 37008414 PMCID: PMC10052560 DOI: 10.1017/jns.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
Abstract
Selenium (Se) is an essential trace element which has an important role as a constituent of seleno-proteins involved in various physiological processes. Previous research in Irish adults suggests that intakes of this important nutrient are suboptimal. The aim of the present study was to estimate the current intakes and major food sources of Se by Irish adults. Mean daily intakes (MDIs) of Se were calculated using data from the National Adult Nutrition Survey which involved 1500 Irish adults aged 18–90 years. The Se content of foods and drinks consumed over a 4-d period was determined using data from the Irish Total Diet Study (TDS). Adequacy of Se intakes was assessed by calculating the proportion of the population with intakes below the adequate intake (AI) of 70 μg/d and lower reference nutrient intake of 40 μg/d (LRNI). The MDI of Se in the total population was 71⋅7 μg/d, with significantly higher intakes reported in men (80⋅2 μg/d) compared with women (63⋅4 μg/d, P < 0⋅01). Meat and meat products were the major contributing food group to Se intakes for both men (37 %) and women (31 %). Overall, 47 % of the population were not meeting the recommended AI, while 4 % of the total population were not meeting the LRNI. Although the average intake of Se is above the AI, a significant proportion of the population is not meeting this recommendation and continued monitoring of Se intakes is necessary, particularly by at-risk groups and also in the context of sustainability.
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McCarthy K, Laird E, O'Halloran AM, Walsh C, Healy M, Fitzpatrick AL, Walsh JB, Hernández B, Fallon P, Molloy AM, Kenny RA. Association between vitamin D deficiency and the risk of prevalent type 2 diabetes and incident prediabetes: A prospective cohort study using data from The Irish Longitudinal Study on Ageing (TILDA). EClinicalMedicine 2022; 53:101654. [PMID: 36147626 PMCID: PMC9486023 DOI: 10.1016/j.eclinm.2022.101654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is hypothesized that vitamin D contributes to the aetiology of type 2 diabetes mellitus (diabetes). This study's objective was to examine the relationships between baseline vitamin D status (as measured by plasma 25-hydroxyvitamin D concentration) and both prevalent diabetes and prospective risk of developing diabetes, including prediabetes, in a population with historically low levels of vitamin D. METHODS In this prospective cohort study, data from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged ≥50 years residing in Ireland were analysed, including wave 1 (October 2009-June 2011) (n = 5272) and wave 3 (March 2014-October 2015) (n = 3828). Those aged <50 years at baseline or who did not complete the health assessment were excluded. Logistic regression models examined the associations between baseline vitamin D concentration (nmol/L) with prevalent diabetes status and incident diabetes/prediabetes collected at a 4-year follow-up. Models were adjusted for age, sex, education, body mass index, smoking history, physical activity, use of statins, and the season in which the vitamin D concentration was sampled. FINDINGS Deficient baseline vitamin D concentration was cross-sectionally associated with an increased likelihood of having prevalent diabetes (Relative Risk Ratio [RRR] 1·5, 95% CI: 1·03, 2·18; p = 0·037). In longitudinal analyses evaluating diabetes status 4 years later, there was a 62% increased likelihood (RRR: 1·62, 95% CI: 1·12, 2·35; p = 0·011) of developing prediabetes for those with vitamin D <30 nmol/L compared to those with ≥75 nmol/L. The rate of progression from prediabetes to diabetes between wave 1 and 3 was observed to be 32·5%. INTERPRETATION Those with lower concentrations of vitamin D, as measured by 25-hydroxyvitamin D, may have different risk profiles with regards to their glycaemic status. Our study had limited power due to the low incidence of diabetes but showed strong associations with incident prediabetes, so further research is required. Optimising vitamin D status at a population level may significantly reduce diabetes. FUNDING TILDA is funded by Atlantic Philanthropies, the Irish Department of Health, and Irish Life, while additional funding was provided by the Irish Department of Agriculture, Food and the Marine (13F492) to cover the cost of 25-hydroxyvitamin D analysis.
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Affiliation(s)
- Kevin McCarthy
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Corresponding author at: The Irish Longitudinal Study on Ageing (TILDA), Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.
| | - Eamon Laird
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling M. O'Halloran
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Martin Healy
- Biochemistry Department, Laboratory Medicine & Molecular Pathology, St James's Hospital, Dublin, Ireland
| | - Annette L. Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, United States of America
| | - James B. Walsh
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Belinda Hernández
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Padraic Fallon
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Anne M. Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Krušič S, Hribar M, Hafner E, Žmitek K, Pravst I. Use of Branded Food Composition Databases for the Exploitation of Food Fortification Practices: A Case Study on Vitamin D in the Slovenian Food Supply. Front Nutr 2022; 8:775163. [PMID: 35059424 PMCID: PMC8763681 DOI: 10.3389/fnut.2021.775163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/12/2021] [Indexed: 12/11/2022] Open
Abstract
Vitamin D deficiency is a worldwide public health concern, which can be addressed with voluntary or mandatory food fortification. The aim of this study was to determine if branded food composition databases can be used to investigate voluntary fortification practices. A case study was conducted using two nationally representative cross-sectional datasets of branded foods in Slovenia, collected in 2017 and 2020, and yearly sales data. Using food labeling data we investigated prevalence of fortification and average vitamin D content, while nutrient profiling was used to investigate overall nutritional quality of the foods. In both datasets, the highest prevalence of vitamin D fortification was observed in meal replacements (78% in 2017; 100% in 2020) and in margarine, corresponding to high market share. Other food categories commonly fortified with vitamin D are breakfast cereals (5% in 2017; 6% in 2020), yogurts and their imitates (5% in 2017; 4% in 2020), and baby foods (18% in both years). The highest declared average content of vitamin D was observed in margarine and foods for specific dietary use (7-8 μg/100g), followed by breakfast cereals (4 μg/100g), while the average content in other foods was below 2 μg/100g. Only minor differences were observed between 2017 and 2020. Major food-category differences were also observed in comparison of the overall nutritional quality of the fortified foods; higher overall nutritional quality was only observed in fortified margarine. Our study showed that branded food composition databases are extremely useful resources for the investigation and monitoring of fortification practices, particularly if sales data can also be used. In the absence of mandatory or recommended fortification in Slovenia, very few manufacturers decide to add vitamin D, and even when this is the case, such products are commonly niche foods with lower market shares. We observed exceptions in imported foods, which can be subject to fortification policies introduced in other countries.
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Affiliation(s)
- Sanja Krušič
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia
| | - Maša Hribar
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Edvina Hafner
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Žmitek
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia
- VIST—Faculty of Applied Sciences, Ljubljana, Slovenia
| | - Igor Pravst
- Nutrition Institute, Nutrition and Public Health Research Group, Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
- VIST—Faculty of Applied Sciences, Ljubljana, Slovenia
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Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets. Indian Pediatr 2021. [DOI: 10.1007/s13312-022-2448-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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7
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McCartney DM, O'Shea PM, Faul JL, Healy MJ, Byrne G, Griffin TP, Walsh JB, Byrne DG, Kenny RA. Vitamin D and SARS-CoV-2 infection-evolution of evidence supporting clinical practice and policy development : A position statement from the Covit-D Consortium. Ir J Med Sci 2021; 190:1253-1265. [PMID: 33219912 PMCID: PMC7679797 DOI: 10.1007/s11845-020-02427-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Daniel M McCartney
- School of Biological and Health Sciences, College of Sciences & Health, Technological University Dublin - City Campus, Dublin 8, Ireland.
| | - Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John L Faul
- James Connolly Memorial Asthma Research Centre, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Martin J Healy
- Biochemistry Department, St. James's Hospital, Dublin 8, Ireland
| | - Greg Byrne
- School of Biological and Health Sciences, College of Sciences & Health, Technological University Dublin - City Campus, Dublin 8, Ireland
| | - Tomás P Griffin
- Regenerative Medicine Institute at CÚRAM SFI Research Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Centre for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
| | - James Bernard Walsh
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Declan G Byrne
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Medicine Directorate, St. James's Hospital, Dublin 8, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Vatanparast H, Patil RP, Islam N, Shafiee M, Whiting SJ. Vitamin D Intake from Supplemental Sources but Not from Food Sources Has Increased in the Canadian Population Over Time. J Nutr 2020; 150:526-535. [PMID: 31825071 PMCID: PMC7056613 DOI: 10.1093/jn/nxz291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/09/2019] [Accepted: 11/06/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Evidence is lacking to determine whether there have been any changes in dietary or total usual intakes of vitamin D among Canadians, in the light of recent evidence of beneficial health effects beyond bone. OBJECTIVE We aimed to examine trends in dietary and total usual intake of vitamin D among Canadians aged ≥1 y. METHODS This study used nationally representative nutrition data from the Canadian Community Health Survey Cycle 2.2 (CCHS 2004) and CCHS Nutrition in 2015. Dietary intake data were collected with use of two 24-h dietary recalls and dietary supplement use was determined by questionnaire. The National Cancer Institute method was used to estimate the usual intake of vitamin D as well as the prevalence of vitamin D inadequacy among Canadians aged ≥1 y. RESULTS From 2004 to 2015, the usual intake of vitamin D from food significantly decreased (P < 0.05) by 1 μg/d only in vitamin D supplement nonusers. The contribution of Milk and Alternatives food group (i.e., fluid milk, fortified soy beverages, powdered milk, and other milk alternatives) to dietary vitamin D intake significantly decreased (P < 0.05) in both supplement users (by 7.1%) and nonusers (by 5.8%). Prevalence of vitamin D supplement use and percentage contribution of vitamin D from supplemental sources significantly increased (P < 0.05) by 5.0% and 14.9%, respectively, from 2004 to 2015. Total usual intake of vitamin D (food + supplement) significantly increased (P < 0.05) from 15.1 ± 0.3 μg/d in 2004 to 31.5 ± 1.8 μg/d in 2015 in vitamin D supplement users. In contrast to vitamin D supplement nonusers, the prevalence of vitamin D inadequacy significantly decreased (P < 0.05) from 20.6% to 14.1% among users of vitamin D supplements. CONCLUSIONS The prevalence of vitamin D supplement use and the percentage contribution of vitamin D from supplemental sources has increased in the Canadian population over an 11-y period.
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Affiliation(s)
- Hassan Vatanparast
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada,Address correspondence to HV (e-mail: )
| | - Rashmi Prakash Patil
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
| | - Naorin Islam
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
| | - Mojtaba Shafiee
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
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Smith M, O’Brien EC, Alberdi G, Geraghty AA, Kilbane M, McKenna MJ, McAuliffe FM. Association between vitamin D status in early pregnancy and atopy in offspring in a vitamin D deplete cohort. Ir J Med Sci 2019; 189:563-570. [DOI: 10.1007/s11845-019-02078-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/03/2019] [Indexed: 12/21/2022]
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10
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Lips P, Cashman KD, Lamberg-Allardt C, Bischoff-Ferrari HA, Obermayer-Pietsch B, Bianchi ML, Stepan J, El-Hajj Fuleihan G, Bouillon R. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol 2019; 180:P23-P54. [PMID: 30721133 DOI: 10.1530/eje-18-0736] [Citation(s) in RCA: 368] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L or 20 ng/mL) is common in Europe and the Middle East. It occurs in <20% of the population in Northern Europe, in 30-60% in Western, Southern and Eastern Europe and up to 80% in Middle East countries. Severe deficiency (serum 25(OH)D <30 nmol/L or 12 ng/mL) is found in >10% of Europeans. The European Calcified Tissue Society (ECTS) advises that the measurement of serum 25(OH)D be standardized, for example, by the Vitamin D Standardization Program. Risk groups include young children, adolescents, pregnant women, older people (especially the institutionalized) and non-Western immigrants. Consequences of vitamin D deficiency include mineralization defects and lower bone mineral density causing fractures. Extra-skeletal consequences may be muscle weakness, falls and acute respiratory infection, and are the subject of large ongoing clinical trials. The ECTS advises to improve vitamin D status by food fortification and the use of vitamin D supplements in risk groups. Fortification of foods by adding vitamin D to dairy products, bread and cereals can improve the vitamin D status of the whole population, but quality assurance monitoring is needed to prevent intoxication. Specific risk groups such as infants and children up to 3 years, pregnant women, older persons and non-Western immigrants should routinely receive vitamin D supplements. Future research should include genetic studies to better define individual vulnerability for vitamin D deficiency, and Mendelian randomization studies to address the effect of vitamin D deficiency on long-term non-skeletal outcomes such as cancer.
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Affiliation(s)
- Paul Lips
- Endocrine Section, Department of Internal Medicine, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | - Kevin D Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, Department of Medicine, University College Cork, Cork, Ireland
| | - Christel Lamberg-Allardt
- Calcium Research Unit, Department of Food and Nutritional Sciences, University of Helsinki, Helsinki, Finland
| | | | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Jan Stepan
- Institute of Rheumatology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roger Bouillon
- Clinic and Laboratory of Endocrinology, Gasthuisberg, KU Leuven, Leuven, Belgium
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11
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Abstract
One hundred years has passed since the discovery of vitamin D as the active component of cod-liver oil which cured the bone disease rickets. Since then our knowledge of vitamin D has expanded tremendously and has included recognition of the importance of UV radiation as a source of the vitamin as well as the discovery of the vitamin as a nutrient, a pro-hormone and a potent steroid hormone with a major role in calcium and bone metabolism. In the last 25 years or so, the discovery of the vitamin D receptor in over 30 different body tissues together with the existence of the alpha-1-hydroxylase enzyme in these tissues provided evidence of a pleiotropic role of vitamin D outside its classical role in the skeleton. These important discoveries have provided the basis for the increasing interest in vitamin D in the context of nutritional requirements for health including the prevention of chronic diseases of ageing. The recent publication of the Dietary Reference Intake report on vitamin D and calcium by the North American Institute of Medicine (IOM) is the most comprehensive report to date on the basis for setting nutritional requirements for vitamin D. This chapter will summarize the nutritional aspects of vitamin D and discuss the changes in vitamin D metabolism and requirements with ageing. It will summarize key evidence on the relationship between vitamin D status and some of the main ageing related health outcomes including bone, muscle and cognitive health as well as survival focusing on the published literature in very-old adults (those >= 85 years of age).
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Affiliation(s)
- Tom R Hill
- Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK.
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
- Institute of Ageing, Newcastle University, Newcastle Upon Tyne, UK.
| | - Antoneta Granic
- Institute of Ageing, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle Upon Tyne, UK
| | - Terence J Aspray
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Ageing, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle Upon Tyne, UK
- The Bone Clinic, Freeman Hospital, Newcastle Upon Tyne, UK
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12
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Windrim CM, Crosby DA, Mitchell K, Brophy C, Mahony R, Higgins M. Vitamin D supplementation in pregnancy-a survey of compliance with recommendations. Ir J Med Sci 2017; 187:709-712. [PMID: 29159790 DOI: 10.1007/s11845-017-1707-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitamin D deficiency in pregnancy has important maternal and fetal implications, with increased risk of developing gestational diabetes, preeclampsia, preterm birth and small for gestational age birthweight. It is recommended that every pregnant woman should take 5 μg (200 IU) of vitamin D per day during pregnancy and lactation. AIMS This study aimed to determine the prevalence of women taking vitamin D supplementation and to identify the reasons for patients not taking supplementation within women attending an antenatal clinic in Dublin. METHODS Survey of women attending the antenatal clinic of the National Maternity Hospital Dublin during 2 weeks in January 2017. Women were asked to record demographics, medical comorbidities and use of vitamin D supplementation or any other supplements in pregnancy, as well as reasons for non-use if appropriate. RESULTS Three hundred women were invited to participate and 175 completed the questionnaire (58%). Overall, 38.9% (n = 68) reported to be taking vitamin D supplementation. Of the women that reported not to be taking vitamin D supplementation, 57.9% (n = 62) were taking a pregnancy multivitamin that contained vitamin D, and 28.0% (n = 30) did not know that it was recommended in pregnancy. Therefore, a total of 45 women (25.7%) in our cohort were taking no vitamin D supplementation during pregnancy. There was no difference in non-use based on maternal age, BMI, parity, or country of origin. CONCLUSIONS Of the women surveyed, 74.3% reported supplementation with vitamin D, either knowingly or unknowingly. Public health initiatives need to utilize this relatively safe, low-cost intervention to maximize maternal and fetal health. This could reduce the rates of antenatal conditions with associated high morbidity and healthcare burden such as gestational diabetes and preeclampsia.
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Affiliation(s)
- C M Windrim
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland
| | - D A Crosby
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland
| | - K Mitchell
- National Maternity Hospital, Dublin, Ireland
| | - C Brophy
- Midwifery, National Maternity Hospital, Dublin, Ireland
| | - R Mahony
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland
| | - M Higgins
- Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Holles St, Dublin 2, Ireland.
- UCD Perinatal Research Center, National Maternity Hospital, University College Dublin, Dublin, Ireland.
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13
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Vitamin D3 supplementation in healthy adults: a comparison between capsule and oral spray solution as a method of delivery in a wintertime, randomised, open-label, cross-over study. Br J Nutr 2016; 116:1402-1408. [PMID: 27724992 DOI: 10.1017/s0007114516003470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Vitamin D is typically supplied in capsule form, both in trials and in clinical practice. However, little is known regarding the efficacy of vitamin D administered via oral sprays - a method that primarily bypasses the gastrointestinal absorption route. This study aimed to compare the efficacy of vitamin D3 liquid capsules and oral spray solution in increasing wintertime total 25-hydroxyvitamin D (25(OH)D) concentrations. In this randomised, open-label, cross-over trial, healthy adults (n 22) received 3000 IU (75 µg) vitamin D3 daily for 4 weeks in either capsule or oral spray form. Following a 10-week washout phase, participants received the opposite treatment for a final 4 weeks. Anthropometrics and fasted blood samples were obtained before and after supplementation, with samples analysed for total 25(OH)D, creatinine, intact parathyroid hormone and adjusted Ca concentrations. At baseline, vitamin D sufficiency (total 25(OH)D>50 nmol/l), insufficiency (31-49 nmol/l) and clinical deficiency (<30 nmol/l) were evident in 59, 23 and 18 % of the participants, respectively. Overall, baseline total mean 25(OH)D concentration averaged 59·76 (sd 29·88) nmol/l, representing clinical sufficiency. ANCOVA revealed no significant difference in the mean and standard deviation change from baseline in total 25(OH)D concentrations between oral spray and capsule supplementation methods (26·15 (sd 17·85) v. 30·38 (sd 17·91) nmol/l, respectively; F=1·044, adjusted r 2 0·493, P=0·313). Oral spray vitamin D3 is an equally effective alternative to capsule supplementation in healthy adults.
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The role of fortified foods and nutritional supplements in increasing vitamin D intake in Irish preschool children. Eur J Nutr 2016; 56:1219-1231. [DOI: 10.1007/s00394-016-1171-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
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Kiely M, Collins A, Lucey AJ, Andersen R, Cashman KD, Hennessy Á. Development, validation and implementation of a quantitative food frequency questionnaire to assess habitual vitamin D intake. J Hum Nutr Diet 2016; 29:495-504. [DOI: 10.1111/jhn.12348] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. Kiely
- Vitamin D Research Group; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (Infant); University College Cork; Cork Ireland
| | - A. Collins
- Vitamin D Research Group; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
| | - A. J. Lucey
- Vitamin D Research Group; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
| | - R. Andersen
- National Food Institute; Technical University of Denmark; Copenhagen Denmark
| | - K. D. Cashman
- Vitamin D Research Group; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
- Department of Medicine; University College Cork; Cork Ireland
| | - Á. Hennessy
- Vitamin D Research Group; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
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Black LJ, Walton J, Flynn A, Cashman KD, Kiely M. Small Increments in Vitamin D Intake by Irish Adults over a Decade Show That Strategic Initiatives to Fortify the Food Supply Are Needed. J Nutr 2015; 145:969-76. [PMID: 25761500 DOI: 10.3945/jn.114.209106] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/20/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Food fortification could be an effective method of increasing vitamin D intakes and preventing deficiency with minimal risk of excessive dosing. OBJECTIVE Secular trends in vitamin D intakes were examined over a 10-y period. METHODS We compared vitamin D intakes among 18- to 64-y-old adults from the base diet, fortified foods, and supplements in 2 nationally representative dietary surveys in 1999 and 2009 implemented using the same methodology. RESULTS There was a slight increase in the median (IQR) intake of vitamin D from 2.9 (3.2) to 3.5 (3.7) μg/d (mean ± SD, 4.3 ± 4.0 to 5.0 ± 6.4 μg). The median (IQR) intake from the base diet was 2.3 (1.6) μg/d in 1999 and 2.1 (1.8) μg/d in 2009. In vitamin D supplement users, median (IQR) intakes were 7.6 (6.7) and 8.7 (7.2) μg/d and the prevalence of inadequacy decreased from 67% to 57% in 2009. Although the consumption of vitamin D-containing supplements was similar in the 2 surveys (17% and 16%), the use of calcium-vitamin D supplements increased from 3% to 10% among women aged 50-64 y. The prevalence of fortified food consumption was also similar at 60%, and median (IQR) vitamin D intakes in consumers were 2.9 (2.2) and 3.7 (2.9) μg/d in 1999 and 2009, respectively. Mathematical modeling of food fortification using modified vitamin D composition data showed that there is potential to increase vitamin D intakes at the lower end of the distribution, without increasing the risk of exceeding the Tolerable Upper Intake Level. CONCLUSIONS We report small increases in vitamin D intakes among Irish adults over a decade of focus on vitamin D and in the context of a voluntary fortification policy. Strategic management of vitamin D in the food supply is required to yield measurable benefits.
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Affiliation(s)
- Lucinda J Black
- Vitamin D Research Group, School of Food and Nutritional Sciences
| | | | | | - Kevin D Cashman
- Vitamin D Research Group, School of Food and Nutritional Sciences, Department of Medicine, and
| | - Mairead Kiely
- Vitamin D Research Group, School of Food and Nutritional Sciences, Irish Center for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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Abstract
Interest in Vitamin D has risen considerably recently with many athletes now advised to take daily vitamin D supplements. The reason for this interest is partly not only attributed to the resurgence of the Vitamin D-deficient disease rickets but also due to the discovery of a Vitamin D receptor in many tissues suggesting a more global role for Vitamin D than previously considered. Unlike the other vitamins that are obtained through the diet, Vitamin D is unique since endogenous synthesis following ultraviolet B (UVB) exposure is the predominant route of entry into systemic circulation. Moreover, Vitamin D could be better classed as a seco-steroid, given that its structure is similar to that of a steroid, and its production is derived from a cholesterol precursor (7-dehydrocholesteol) in the skin. The classification of Vitamin D status is currently subject to considerable debate with many authors opposing governing body recommendations. Regardless of the suggested optimal concentration, there is now growing evidence to suggest that many athletes are in fact Vitamin D deficient, especially in the winter months largely as a consequence of inadequate sun exposure, combined with poor dietary practices, although the consequences of such deficiencies are still unclear in athletic populations. Impaired muscle function and reduced regenerative capacity, impaired immune function, poor bone health and even impaired cardiovascular function have all been associated with low Vitamin D in athletes, however, to date, the majority of studies on Vitamin D have described associations and much more research is now needed examining causation.
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Affiliation(s)
- Daniel J Owens
- a Research Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
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18
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Vitamin D: can fish food-based solutions be used for reduction of vitamin D deficiency in Poland? Nutrition 2014; 31:187-92. [PMID: 25466665 DOI: 10.1016/j.nut.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The multitude of diseases promoted by vitamin D deficiency makes providing the human organism with a constant and sufficiently high supply of this compound a high priority. The aim of this study was to verify the extent to which fish present in the Polish diet can satisfy the body's requirement for this compound. The obtained data would help to evaluate whether a diet rich in fish may be a solution for vitamin D deficiency. METHODS Cholecalciferol and ergocalciferol in muscle tissues of fish species popular in the Polish market were determined by means of high-performance liquid chromatography. Based on these updated data, and on data regarding fish consumption, it was possible to assess the level of vitamin D intake provided by fish consumption. RESULTS This study proved that some of the investigated species of fish are a good source of vitamin D3. Among wild fish, Baltic salmon and herring contained the highest amount of cholecalciferol. Surprisingly, the highest content of this compound was observed in lean tilapia, farmed in China. Ergocalciferol also was found in the studied fish samples. CONCLUSION Analysis of vitamin D content in various fish species indicated that the disproportion between requirement and supply seems too vast to enable eradication of vitamin D deficiency by fish food-based solutions. Still, increasing fish consumption or changing consumption patterns could be beneficial and result in noticeable improvements in vitamin D status.
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Cashman KD, Kinsella M, Walton J, Flynn A, Hayes A, Lucey AJ, Seamans KM, Kiely M. The 3 epimer of 25-hydroxycholecalciferol is present in the circulation of the majority of adults in a nationally representative sample and has endogenous origins. J Nutr 2014; 144:1050-7. [PMID: 24828024 PMCID: PMC4056645 DOI: 10.3945/jn.114.192419] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Fundamental knowledge gaps in relation to the 3 epimer of 25-hydroxycholecalciferol [3-epi-25(OH)D₃] limit our understanding of its relevance for vitamin D nutrition and health. The aims of this study were to characterize the 3-epi-25(OH)D₃ concentrations in a nationally representative sample of adults and explore its determinants. We also used data from a recent randomized controlled trial (RCT) of supplemental cholecalciferol (vitamin D₃) conducted in winter in older adults to directly test the impact of changes in vitamin D status on serum 3-epi-25(OH)D3 concentrations. Serum 25-hydroxycholecalciferol [25(OH)D₃] and 3-epi-25(OH)D₃ concentrations (via LC-tandem mass spectrometry) from our vitamin D₃ RCT in adults (aged ≥50 y) and data on dietary, lifestyle, and biochemical characteristics of participants of the recent National Adult Nutrition Survey in Ireland (aged 18-84 y; n = 1122) were used in the present work. In the subsample of participants who had serum 3-epi-25(OH)D₃ concentrations greater than the limit of quantification (n = 1082; 96.4%), the mean, 10th, 50th (median), and 90th percentile concentrations were 2.50, 1.05, 2.18, and 4.30 nmol/L, respectively, whereas the maximum 3-epi-25(OH)D₃ concentration was 15.0 nmol/L. A regression model [explaining 29.9% of the variability in serum 3-epi-25(OH)D₃] showed that age >50 y, vitamin D supplement use, dietary vitamin D, meat intake, season of blood sampling, and sun exposure habits were significant positive determinants, whereas increasing waist circumference and serum 25-hydroxyergocalciferol concentration were significant negative determinants. The RCT data showed that mean serum 25(OH)D₃ and 3-epi-25(OH)D₃ concentrations increased (49.3% and 42.1%, respectively) and decreased (-28.0% and -29.1%, respectively) significantly (P < 0.0001) with vitamin D₃ (20 μg/d) and placebo supplementation, respectively, over 15 wk of winter. In conclusion, we provide data on serum 3-epi-25(OH)D₃ in a nationally representative sample of adults. Our combined observational and RCT data might suggest that both dietary supply and dermal synthesis of vitamin D₃ contribute to serum 3-epi-25(OH)D₃ concentration.
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Affiliation(s)
- Kevin D. Cashman
- School of Food and Nutritional Sciences and,Department of Medicine, University College Cork, Cork, Ireland,To whom correspondence should be addressed. E-mail:
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20
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Dietary vitamin D₂--a potentially underestimated contributor to vitamin D nutritional status of adults? Br J Nutr 2014; 112:193-202. [PMID: 24780068 DOI: 10.1017/s0007114514000725] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It has been suggested that vitamin D₂ is not very prevalent in the human food chain. However, data from a number of recent intervention studies suggest that the majority of subjects had measurable serum 25-hydroxyvitamin D₂ (25(OH)D₂) concentrations. Serum 25(OH)D₂, unlike 25(OH)D₃, is not directly influenced by exposure of skin to sun and thus has dietary origins; however, quantifying dietary vitamin D₂ is difficult due to the limitations of food composition data. Therefore, the present study aimed to characterise serum 25(OH)D₂ concentrations in the participants of the National Adult Nutrition Survey (NANS) in Ireland, and to use these serum concentrations to estimate the intake of vitamin D₂ using a mathematical modelling approach. Serum 25(OH)D₂ concentration was measured by a liquid chromatography-tandem MS method, and information on diet as well as subject characteristics was obtained from the NANS. Of these participants, 78.7 % (n 884) had serum 25(OH)D₂ concentrations above the limit of quantification, and the mean, maximum, 10th, 50th (median) and 90th percentile values of serum 25(OH)D₂ concentrations were 3.69, 27.6, 1.71, 2.96 and 6.36 nmol/l, respectively. To approximate the intake of vitamin D₂ from these serum 25(OH)D₂ concentrations, we used recently published data on the relationship between vitamin D intake and the responses of serum 25(OH)D concentrations. The projected 5th to 95th percentile intakes of vitamin D₂ for adults were in the range of 0.9-1.2 and 5-6 μg/d, respectively, and the median intake ranged from 1.7 to 2.3 μg/d. In conclusion, the present data demonstrate that 25(OH)D₂ concentrations are present in the sera of adults from this nationally representative sample. Vitamin D₂ may have an impact on nutritional adequacy at a population level and thus warrants further investigation.
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21
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Cashman KD, Kiely M. Recommended dietary intakes for vitamin D: Where do they come from, what do they achieve and how can we meet them? J Hum Nutr Diet 2014; 27:434-42. [PMID: 24580775 DOI: 10.1111/jhn.12226] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is substantial evidence that the prevalence of vitamin D deficiency is high across Europe, particularly, but not exclusively, among those resident at Northerly latitudes. This has significant implications for human health throughout the lifecycle and impacts upon healthy growth and development and successful ageing for current and possibly future generations. In recent years, there have been several important reports from North America and Europe in relation to dietary reference values (DRVs) for vitamin D. These may be of enormous value from a public health perspective in terms of preventing vitamin D deficiency and promoting adequate vitamin D status in the population. In this concise review, we provide a brief summary of current DRVs for vitamin D, their background and their application to vitamin D deficiency prevention. The review also provides some brief guidance with respect to applying the DRVs in a clinical nutrition setting. In addition, the review illustrates how current dietary intakes of most populations, young and adult, are well short of the newly established DRVs. Accordingly, the review highlights potential food-based or dietary strategies for increasing the distribution of vitamin D intake in the population with the aim of preventing vitamin D deficiency. Finally, despite the explosion in scientific research in vitamin D and health, there are many fundamental gaps in the field of vitamin D from the public health perspective. The impact of these knowledge gaps on current DRVs for vitamin D is highlighted, as are some future developments that may help address these gaps.
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Affiliation(s)
- K D Cashman
- Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland; Department of Medicine, University College Cork, Cork, Ireland
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22
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Abstract
The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.
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Toher C, Lindsay K, McKenna M, Kilbane M, Curran S, Harrington L, Uduma O, McAuliffe FM. Relationship between vitamin D knowledge and 25-hydroxyvitamin D levels amongst pregnant women. J Hum Nutr Diet 2013; 27:261-9. [DOI: 10.1111/jhn.12150] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Toher
- Centre for Global Health; Trinity College; Dublin Ireland
| | - K. Lindsay
- UCD Obstetrics and Gynaecology; School of Medicine and Medical Science; National Maternity Hospital; University College Dublin; Dublin Ireland
| | - M. McKenna
- Metabolism Laboratory; St Vincent's University Hospital; Dublin Ireland
| | - M. Kilbane
- Metabolism Laboratory; St Vincent's University Hospital; Dublin Ireland
| | - S. Curran
- Department of Dietetics; National Maternity Hospital; Dublin Ireland
| | - L. Harrington
- Department of Dietetics; Rotunda Hospital; Dublin Ireland
| | - O. Uduma
- Centre for Global Health; Trinity College; Dublin Ireland
| | - F. M. McAuliffe
- UCD Obstetrics and Gynaecology; School of Medicine and Medical Science; National Maternity Hospital; University College Dublin; Dublin Ireland
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González-Rodríguez LG, Estaire P, Peñas-Ruiz C, Ortega RM. Vitamin D intake and dietary sources in a representative sample of Spanish adults. J Hum Nutr Diet 2013; 26 Suppl 1:64-72. [PMID: 23600788 DOI: 10.1111/jhn.12061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D plays an essential role in bone mineralisation and its deficiency is associated with several chronic diseases. Some studies have reported a deficient status of vitamin D in Spanish and European population. The present study aimed to assess vitamin D intake, dietary sources of this nutrient and its adequacy with respect to the dietary reference intakes (DRI) in a representative sample of Spanish adults. METHODS Four hundred and eighteen adults (aged 18-60 years) from 15 Spanish provinces were studied. They constituted a representative sample of the Spanish adult population. Energy and nutrient intake were determined using a 24-h dietary recall questionnaire for two consecutive days. Vitamin D intake was compared with the DRI for this vitamin. RESULTS Mean (SD) vitamin D intake was 3.5 (4.0) μg day(-1) (69.5% of the DRI). Of the participants studied, 81.6% had vitamin D intakes below the DRI and 68.7% had intakes below 67% of the DRI. Of the vitamin D, 91.4% came from food sources and 8.6% came from dietary supplements. The main food sources of vitamin D were fish, eggs, dairy products, cereals, oils and meat. In addition, those subjects who met the DRI for vitamin D had a higher consumption of fish, vegetables and fruits and a lower consumption of meats than those subjects who did not meet the DRI. CONCLUSIONS Vitamin D intake was inadequate in the sample of the adult Spanish population. Therefore, an increase in the consumption of oily fish, as well as fortified dairy products and cereals, might help to improve vitamin D intake.
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Affiliation(s)
- L G González-Rodríguez
- Departamento de Nutrición, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain.
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25
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Cashman KD, Kiely M. EURRECA—Estimating Vitamin D Requirements for Deriving Dietary Reference Values. Crit Rev Food Sci Nutr 2013; 53:1097-109. [DOI: 10.1080/10408398.2012.742862] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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26
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Abstract
Previous national nutrition surveys in Irish adults did not include blood samples; thus, representative serum 25-hydroxyvitamin D (25(OH)D) data are lacking. In the present study, we characterised serum 25(OH)D concentrations in Irish adults from the recent National Adult Nutrition Survey, and determined the impact of vitamin D supplement use and season on serum 25(OH)D concentrations. Of the total representative sample (n 1500, aged 18+ years), blood samples were available for 1132 adults. Serum 25(OH)D was measured via immunoassay. Vitamin D-containing supplement use was assessed by questionnaire and food diary. Concentrations of serum 25(OH)D were compared by season and in supplement users and non-users. Year-round prevalence rates for serum 25(OH)D concentration < 30, < 40, < 50 and < 75 nmol/l were 6.7, 21.9, 40.1 and 75.6 %, respectively (11.1, 31.1, 55.0 and 84.0 % in winter, respectively). Supplement users had significantly higher serum 25(OH)D concentrations compared to non-users. However, 7.5 % of users had winter serum 25(OH)D < 30 nmol/l. Only 1.3 % had serum 25(OH)D concentrations >125 nmol/l. These first nationally representative serum 25(OH)D data for Irish adults show that while only 6.7 % had serum 25(OH)D < 30 nmol/l (vitamin D deficiency) throughout the year, 40.1 % had levels considered by the Institute of Medicine as being inadequate for bone health. These prevalence estimates were much higher during winter time. While vitamin D supplement use has benefits in terms of vitamin D status, at present rates of usage (17.5 % of Irish adults), it will have only very limited impact at a population level. Food-based strategies, including fortified foods, need to be explored.
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Usydus Z, Szlinder-Richert J. Functional Properties of Fish and Fish Products: A Review. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2012. [DOI: 10.1080/10942912.2010.503356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cashman KD, Seamans KM, Lucey AJ, Stöcklin E, Weber P, Kiely M, Hill TR. Relative effectiveness of oral 25-hydroxyvitamin D3 and vitamin D3 in raising wintertime serum 25-hydroxyvitamin D in older adults. Am J Clin Nutr 2012; 95:1350-6. [PMID: 22552038 DOI: 10.3945/ajcn.111.031427] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The relative potency of 25-hydroxyvitamin D3 to vitamin D3 needs to be better defined so that food-composition tables can better reflect the true vitamin D nutritive value of certain foods. OBJECTIVE We performed a randomized, controlled intervention study in apparently healthy, free-living adults to investigate whether the intake of 25-hydroxyvitamin D3 is 5 times more potent in raising serum 25-hydroxyvitamin D [25(OH)D] during winter compared with an equivalent amount of vitamin D3. DESIGN A randomized, placebo-controlled, double-blind intervention study was conducted in adults aged ≥50 y (n = 56) who consumed a placebo, 20 μg vitamin D3, or 7 or 20 μg 25-hydroxyvitamin D3 daily throughout 10 wk of winter. Serum 25(OH)D was measured by using an enzyme-linked immunoassay, and serum albumin-corrected calcium (S-Ca) was assessed colorimetrically at the baseline, midpoint, and endpoint of the study. RESULTS The mean (±SD) increases (per microgram of vitamin D compound) in serum 25(OH)D concentrations over baseline after 10 wk of supplementation were 0.96 ± 0.62, 4.02 ± 1.27, and 4.77 ± 1.04 nmol · L(-1) · μg intake(-1) for the 20-μg vitamin D3/d and 7- and 20-μg 25-hydroxyvitamin D3/d groups, respectively. A comparison of the 7- and 20-μg 25-hydroxyvitamin D3/d groups with the 20-μg vitamin D3/d group yielded conversion factors of 4.2 and 5, respectively. There was no effect of treatment on S-Ca concentrations and no incidence of hypercalcemia (S-Ca >2.6 nmol/L). CONCLUSIONS Each microgram of orally consumed 25-hydroxyvitamin D3 was about 5 times more effective in raising serum 25(OH)D in older adults in winter than an equivalent amount of vitamin D3. This conversion factor could be used in food-compositional tables for relevant foods. This study was registered at clinicaltrials.gov as NCT01398202.
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Affiliation(s)
- Kevin D Cashman
- School of Food and Nutritional Sciences, Department of Medicine, University College Cork, Cork, Ireland.
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Black LJ, Seamans KM, Cashman KD, Kiely M. An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr 2012; 142:1102-8. [PMID: 22513988 DOI: 10.3945/jn.112.158014] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food fortification is a potentially effective public health strategy to increase vitamin D intakes and circulating 25-hydroxyvitamin D [25(OH)D] concentrations. We updated a previous systematic review to evaluate current evidence from randomized controlled intervention studies in community-dwelling adults of the effect of fortified foods on 25(OH)D concentrations. Ovid MEDLINE, PubMed, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled intervention studies with vitamin D-fortified foods in free-living adults and data on circulating 25(OH)D. Two reviewers independently screened 441 papers for eligibility and extracted the relevant data. A meta-analysis of the absolute mean change in circulating 25(OH)D concentrations was conducted using a random effects model. Sixteen studies from 15 publications were included, of which 14 showed a significant effect of fortified foods on 25(OH)D concentrations. Heterogeneity was high (P = <0.0001, I(2) = 89%) and was partly explained by dose, latitude (range, 3-60°), and baseline 25(OH)D (range, 24.0-83.6 nmol/L). When combined in a random effects analysis (n = 1513; 767 treated, 746 controls), a mean individual intake of ~11 μg/d (440 IU/d) from fortified foods (range, 3-25 μg/d) increased 25(OH)D by 19.4 nmol/L (95% CI: 13.9, 24.9), corresponding to a 1.2 nmol/L (95% CI: 0.72, 1.68) increase in 25(OH)D for each 1 μg ingested. Vitamin D food fortification increases circulating 25(OH)D concentrations in community-dwelling adults. Safe and effective food-based strategies could increase 25(OH)D across the population distribution and prevent vitamin D deficiency with potential benefit for public health.
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Affiliation(s)
- Lucinda J Black
- School of Food and Nutritional Sciences, University College Cork, Cork,Ireland
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Cashman KD. The role of vitamers and dietary-based metabolites of vitamin D in prevention of vitamin D deficiency. Food Nutr Res 2012; 56:5383. [PMID: 22489218 PMCID: PMC3321253 DOI: 10.3402/fnr.v56i0.5383] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
There is little doubt that vitamin D deficiency across all age groups in Europe is a problem. Low vitamin D status arises due to limited, if any, dermal synthesis during the winter months at latitudes above 40°N, putting increased importance on dietary supply of the vitamin. However, dietary intakes by most populations are low due to the limited supply of vitamin D-rich foods in the food chain. Thus strategies that effectively address this public health issue are urgently required. It has been emphasized and re-emphasized that there are only a limited number of public health strategies available to correct low dietary vitamin D intake: (1) improving intake of naturally occurring vitamin D-rich foods, (2) vitamin D fortification (mandatory or voluntarily) of food, and (3) vitamin D supplementation. Recent evidence suggests that the levels of vitamin D added to food would need to be high so as to ensure dietary requirements are met and health outcomes optimized. In addition, knowledge of the most effective forms of vitamin D to use in some of these preventative approaches is important. There is still uncertainty in relation to the relative efficacy of vitamin D2 versus D3, the two main food derived forms and those used in vitamin D supplements. The major metabolite of vitamin D with biological activity is 1,25(OH)2D; however, this is usually used for pharmacological purposes and is not typically used in normal, healthy people. The other major metabolite, 25(OH)D, which has also been used for pharmacological purposes is present in certain foods such as meat and meat products (particularly offal) as well as eggs. This metabolite may have the potential to boost vitamin D status up to five times more effectively that native vitamin D3 in foods. However, the exact bioactivity of this compound needs to be established.
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Affiliation(s)
- Kevin D Cashman
- School of Food and Nutritional Sciences, and Department of Medicine, University College Cork, Cork, Ireland
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Towards prevention of vitamin D deficiency and beyond: knowledge gaps and research needs in vitamin D nutrition and public health. Br J Nutr 2011; 106:1617-27. [PMID: 22017772 DOI: 10.1017/s0007114511004995] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The North American Institute of Medicine (IOM) recently published their report on dietary reference intakes (DRI) for Ca and vitamin D. The DRI committee's deliberations underpinning this most comprehensive report on vitamin D nutrition to date benefited hugely from a much expanded knowledge base in vitamin D over the last decade or more. However, since their release, the vitamin D DRI have been the subject of intense controversy, which is largely due to the persistence of fundamental knowledge gaps in vitamin D. These can be identified at the levels of exposure, metabolism, storage, status, dose-response, function and beneficial or adverse health effects, as well as safe and effective application of intake recommendations at the population level through sustainable food-based approaches. The present review provides a brief overview of the approach used by the IOM committee to revise the DRI for vitamin D and to collate from a number of authoritative sources key knowledge gaps in vitamin D nutrition from the public health perspective. A number of research topics are outlined and data requirements within these are identified and mapped to the risk assessment framework used by the DRI committee. While not intended as an exhaustive list, it provides a basis for organising and prioritising research efforts in the area of vitamin D, which may offer a perspective on the major areas in need of attention. It is intended to be of use to researchers, national policy makers, the public health community, industry groups and other relevant stakeholders including funding institutions.
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Revision of food-based dietary guidelines for Ireland, Phase 2: recommendations for healthy eating and affordability. Public Health Nutr 2011; 15:527-37. [PMID: 21914254 DOI: 10.1017/s1368980011002084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To revise the food-based dietary guidelines for Ireland and assess the affordability of healthy eating. DESIGN An iterative process was used to develop 4 d food intake patterns (n 22) until average intakes met a range of nutrient and energy goals (at moderate and sedentary activity levels) that represented the variable nutritional requirements of all in the population aged 5 years and older. Dietary guidelines were formulated describing the amounts and types of foods that made up these intake patterns. Foods required for healthy eating by typical households in Ireland were priced and affordability assessed as a proportion of relevant weekly social welfare allowances. SETTING Government agency/community. SUBJECTS General population aged 5+ years. RESULTS Food patterns developed achieved energy and nutrient goals with the exception of dietary fibre (inadequate for adults with energy requirements <9·2 MJ) and vitamin D (inadequate for everyone). A new food group to guide on fats/oils intake was developed. Servings within the Bread, Cereal and Potato group were sub-categorized on the basis of energy content. Recommendations on numbers of servings from each food group were developed to guide on energy and nutrient requirements. Healthy eating is least affordable for families with children who are dependent on social welfare. CONCLUSION Daily supplementation with vitamin D is recommended. Wholemeal breads and cereals are recommended as the best source of energy and fibre. Low-fat dairy products and reduced-fat unsaturated spreads are prioritized to achieve saturated fat and energy goals. Interventions are required to ensure that healthy eating is affordable.
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Revision of food-based dietary guidelines for Ireland, Phase 1: evaluation of Ireland's food guide. Public Health Nutr 2011; 15:518-26. [PMID: 21914255 DOI: 10.1017/s1368980011002072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate Ireland's food-based dietary guidelines and highlight priorities for revision. DESIGN Evaluation with stakeholder input. Energy and nutrient intake goals most appropriate for Ireland were determined. Advice from Ireland's food guide was translated into 4 d food intake patterns representing age and gender groups from 5 to 51+ years. Nutritional content of the food patterns was compared with identified goals and appropriateness of food advice was noted. Feedback from stakeholders was obtained on portion size of foods within the Bread, Cereal and Potato group and of portion descriptors for meat and cereal foods. SETTING Government agency/community. SUBJECTS General population aged 5+ years, dietitians/nutritionists (n 44) and 1011 consumers. RESULTS Goals were identified for energy, macronutrients, fibre, Fe, Ca and vitamin D. Goals not achieved by the food patterns included energy, total fat, saturated fat, fibre and vitamin D. Energy content of food portions within the Bread, Cereal and Potato group varied widely, yet advice indicated they were equivalent. Dietitians/nutritionists agreed with the majority of consumers surveyed (74 %, n 745) that larger portion sizes within the Bread, Cereal and Potato group were more meaningful. 'Palm of hand' as a descriptor for meat portions and a '200 ml disposable cup' for quantifying cereal foods were preferred. CONCLUSIONS Revision of the guidelines requires specific guidance on energy and vitamin D intakes, and comprehensive advice on how to reduce fat and saturated fat and increase fibre intakes. Advice should use portion descriptors favoured by consumers and enlarged portion sizes for breads, cereals and potatoes that are equivalent in terms of energy.
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The nutrition transition in the Republic of Ireland: trends in energy and nutrient supply from 1961 to 2007 using Food and Agriculture Organization food balance sheets. Br J Nutr 2011; 106:1078-89. [PMID: 21481289 DOI: 10.1017/s0007114511001395] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the course of the last 50 years the Republic of Ireland has gone from being one of the poorest countries in Europe to one of the richest; however, it is now experiencing increasing rates of obesity and non-communicable chronic disease. Although several national nutrition surveys have been carried out in Ireland since 1990, there is little information on the Irish diet before then. We analysed the FAO food balance sheets for Ireland from 1961 to 2007 in order to characterise the changes in energy and nutrient supply that took place during that period. Food balance sheets were downloaded from the FAOSTAT database and per capita supply of commodities was analysed using dietary analysis software. Energy from carbohydrate as a percentage of total energy fell from 55 % in 1961 to 46 % in 2007, whereas energy from fat increased from 29 % to 34 %; these values are well outside WHO recommendations for the prevention of chronic disease. Energy from alcohol as a percentage of total energy has doubled within the last 20 years. On a nutrient-density basis, vitamins and minerals met or exceeded WHO recommendations, apart from vitamin D, folate, Ca and Fe. Although there are methodological limitations associated with the use of food balance sheets, the present results demonstrate that the current imbalances in the Irish diet were already evident several decades ago. Because they are so long established, they will be difficult to reverse unless major public health nutrition interventions are implemented.
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Laird E, Ward M, McSorley E, Strain JJ, Wallace J. Vitamin D and bone health: potential mechanisms. Nutrients 2010; 2:693-724. [PMID: 22254049 PMCID: PMC3257679 DOI: 10.3390/nu2070693] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 06/22/2010] [Accepted: 06/29/2010] [Indexed: 12/31/2022] Open
Abstract
Osteoporosis is associated with increased morbidity, mortality and significant economic and health costs. Vitamin D is a secosteriod hormone essential for calcium absorption and bone mineralization which is positively associated with bone mineral density [BMD]. It is well-established that prolonged and severe vitamin D deficiency leads to rickets in children and osteomalacia in adults. Sub-optimal vitamin D status has been reported in many populations but it is a particular concern in older people; thus there is clearly a need for effective strategies to optimise bone health. A number of recent studies have suggested that the role of vitamin D in preventing fractures may be via its mediating effects on muscle function (a defect in muscle function is one of the classical signs of rickets) and inflammation. Studies have demonstrated that vitamin D supplementation can improve muscle strength which in turn contributes to a decrease in incidence of falls, one of the largest contributors to fracture incidence. Osteoporosis is often considered to be an inflammatory condition and pro-inflammatory cytokines have been associated with increased bone metabolism. The immunoregulatory mechanisms of vitamin D may thus modulate the effect of these cytokines on bone health and subsequent fracture risk. Vitamin D, therefore, may influence fracture risk via a number of different mechanisms.
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Affiliation(s)
- Eamon Laird
- School of Biomedical Sciences, University of Ulster, Coleraine, UK.
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Evaluating energy intake measurement in free-living subjects: when to record and for how long? Public Health Nutr 2009; 13:172-80. [PMID: 19772686 DOI: 10.1017/s1368980009991443] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To nutritionally analyse mean energy intake (EI) from different 3 d intervals within a 7 d recording period and to evaluate the seasonal effect on energy and nutrient intake. DESIGN Cross-sectional study of dietary intake collected with 7 d food diaries. SETTING Aberdeen, north-east Scotland, UK, between 2002 and 2004. SUBJECTS Participants from two long-term trials were pooled. These trials, investigating genetic and environmental influences on body weight, were the Genotyping And Phenotyping (GAP) study and a cohort observational study, Rowett Assessment of Childhood Appetite and metaboLism (RASCAL). There were 260 Caucasian adults, BMI range 16.7-49.3 kg/m2, age range 21-64 years. RESULTS Mean EI for Wednesday, Friday and Saturday had the closest approximation to the 7 d mean (0.1 % overestimate). A gender x season interaction (P = 0.019) with a different intake pattern for females and males was observed. For females, lower mean (se) EI was recorded in summer (8117 (610) kJ) and autumn (7941 (699) kJ) compared with spring (8929 (979) kJ) and winter (8132 (1041) kJ). For males, higher mean (se) EI was recorded in summer (10 420 (736) kJ) and autumn (10 490 (1041) kJ) compared with spring (9319 (1441) kJ) and winter (9103 (1505) kJ). CONCLUSIONS The study results indicate that 3 d weighed intakes recorded from Wednesday, Friday and Saturday are most representative of 7 d habitual intake in free-living subjects. They also indicate that seasonality has a limited effect on EI and no effect on macronutrient intake.
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How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies. Br J Nutr 2009; 101 Suppl 2:S37-50. [DOI: 10.1017/s0007114509990572] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.
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Fish consumption among young overweight European adults and compliance to varying seafood content in four weight loss intervention diets. Public Health Nutr 2009; 12:592-8. [DOI: 10.1017/s136898000800253x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundFish is considered an important part of a healthy diet and is frequently recommended as a main course at least twice a week.ObjectiveTo study the frequency of fish consumption among young overweight European adults and their compliance to varying seafood consumption in weight loss intervention diets.DesignAfter meeting the inclusion criteria, the subject’s seafood intake was evaluated. Subjects were randomly assigned into four groups and were advised energy-restricted diets for 8 weeks, including no seafood (control), cod, salmon or fish oil. A validated FFQ was used to evaluate the consumption of seafood at baseline, midpoint and endpoint, and long-chain n-3 fatty acids in blood erythrocytes were measured.SettingIceland, Ireland and Spain.SubjectsThe sample (n 324); 20–40-year-olds with BMI = 27·5–32·5 kg/m2; 85 % participated.ResultsAt baseline, 34 % of the participants reported eating fish at least twice a week as the main course. During the intervention, six participants reported that they did not finish their fish portions, 15 % of the participants consumed small amount of fish additional to the study protocol in weeks 1–4 and 23 % in weeks 5–8 (P = 0·010). Changes in erythrocyte long-chain n-3 fatty acids confirmed good compliance, with increases in the salmon (P < 0·001) and fish oil (P < 0·001) groups, smaller increase in the cod group (P = 0·037) and decrease in the control group (P = 0·030).ConclusionFrequency of fish consumption among 66 % of young European overweight adults is lower than frequently recommended. Compliance to varying seafood consumption was good. Therefore, including more fish in the diet of this group should be encouraged.
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Rodríguez-Rodríguez E, Navia B, López-Sobaler AM, Ortega RM. Vitamin D in overweight/obese women and its relationship with dietetic and anthropometric variables. Obesity (Silver Spring) 2009; 17:778-82. [PMID: 19180066 DOI: 10.1038/oby.2008.649] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Overweight/obese persons usually have an inadequate vitamin D status, a situation commonly made worse by an inadequate intake of this vitamin. For this reason, the aim of this study was to analyze dietetic and anthropometric differences in a group of young, overweight/obese Spanish women with respect to their vitamin D status. The study subjects were 66 white Spanish women (aged 20-35 years) with a BMI of 24-35 kg/m(2). Dietetic, anthropometric, and biochemical data were collected. Women were divided into two groups depending on their serum vitamin D concentrations: LD (women with <90 nmol/l 25(OH)D) and HD (women with >or=90 nmol/l 25(OH)D). The intakes of vitamin D, calcium, and supplements were similar in both groups. The body weight, BMI, and waist circumference of the HD subjects were smaller than those recorded for the LD subjects (68.6 +/- 4.2 kg, 26.0 +/- 1.3 kg/m(2), and 79.4 +/- 3.4 cm compared to 76.2 +/- 9.8, 28.6 +/- 3.2 kg/m(2), and 86.2 +/- 9.3 cm, respectively; P < 0.05). The hip circumference and the waist/hip ratio were similar in both groups. A BMI of <27.7 kg/m(2) (P50) was associated with serum vitamin D concentrations of >or=90 nmol/l (odds ratio = 0.1313; confidence interval: 0.0149-1.1599; P < 0.05). Overweight/obese women are at higher risk of vitamin D deficiency, largely due to excess adiposity rather than inadequate intake.
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DiVasta AD, van der Veen KK, Gordon CM. Vitamin D Deficiency in Children and Its Health Consequences. Clin Rev Bone Miner Metab 2009. [DOI: 10.1007/s12018-009-9036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Cashman KD, Hill TR, Lucey AJ, Taylor N, Seamans KM, Muldowney S, Fitzgerald AP, Flynn A, Barnes MS, Horigan G, Bonham MP, Duffy EM, Strain JJ, Wallace JMW, Kiely M. Estimation of the dietary requirement for vitamin D in healthy adults. Am J Clin Nutr 2008; 88:1535-42. [PMID: 19064513 DOI: 10.3945/ajcn.2008.26594] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Knowledge gaps have contributed to considerable variation among international dietary recommendations for vitamin D. OBJECTIVE We aimed to establish the distribution of dietary vitamin D required to maintain serum 25-hydroxyvitamin D [25(OH)D] concentrations above several proposed cutoffs (ie, 25, 37.5, 50, and 80 nmol/L) during wintertime after adjustment for the effect of summer sunshine exposure and diet. DESIGN A randomized, placebo-controlled, double-blind 22-wk intervention study was conducted in men and women aged 20-40 y (n = 238) by using different supplemental doses (0, 5, 10, and 15 microg/d) of vitamin D(3) throughout the winter. Serum 25(OH)D concentrations were measured by using enzyme-linked immunoassay at baseline (October 2006) and endpoint (March 2007). RESULTS There were clear dose-related increments (P < 0.0001) in serum 25(OH)D with increasing supplemental vitamin D(3). The slope of the relation between vitamin D intake and serum 25(OH)D was 1.96 nmol x L(-1) x microg(-1) intake. The vitamin D intake that maintained serum 25(OH)D concentrations of >25 nmol/L in 97.5% of the sample was 8.7 microg/d. This intake ranged from 7.2 microg/d in those who enjoyed sunshine exposure, 8.8 microg/d in those who sometimes had sun exposure, and 12.3 microg/d in those who avoided sunshine. Vitamin D intakes required to maintain serum 25(OH)D concentrations of >37.5, >50, and >80 nmol/L in 97.5% of the sample were 19.9, 28.0, and 41.1 microg/d, respectively. CONCLUSION The range of vitamin D intakes required to ensure maintenance of wintertime vitamin D status [as defined by incremental cutoffs of serum 25(OH)D] in the vast majority (>97.5%) of 20-40-y-old adults, considering a variety of sun exposure preferences, is between 7.2 and 41.1 microg/d.
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Affiliation(s)
- Kevin D Cashman
- Department of Food and Nutritional Sciences, University College, Cork, Ireland.
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Preliminary data about the influence of vitamin D status on the loss of body fat in young overweight/obese women following two types of hypocaloric diet. Br J Nutr 2008; 100:269-72. [DOI: 10.1017/s0007114508894354] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The loss of weight was analysed in a group of sixty overweight/obese women of childbearing age (20–35 years) according to their initial vitamin D status. Subjects were randomly assigned to one of two slightly hypocaloric diets: Diet V, in which the consumption of vegetables was increased, or Diet C, in which the relative consumption of cereals (especially breakfast cereals) was increased. Dietetic, anthropometric and biochemical data were collected at the start of the study and again at 2 weeks after dividing the women into groups depending on their having an initial serum 25-hydroxyvitamin D (25(OH)D) concentration of < 50 nmol/l (LD) or ≥ 50 nmol/l (HD). Dietary intervention led to a reduction in energy intake, body weight and BMI in all groups. The HD women showed greater body fat losses during the study than the LD women (1·7 (sd 1·8) kg compared to 0·5 (sd 0·8) kg). A better vitamin D status therefore aided the loss of body fat over the experimental period (OR 0·462; CI 0·271, 0·785; P < 0·001). However, when the dietary groups were analysed separately, this effect was only seen in the C subjects (OR 0·300; CI 0·121, 0·748; P < 0·001). The present results suggest that women with a better vitamin D status respond more positively to hypocaloric diets and lose more body fat; this was especially clear among the C subjects who had a greater vitamin D supply during the experimental period.
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Validity of a food frequency questionnaire to assess intake of seafood in adults in three European countries. Food Control 2008. [DOI: 10.1016/j.foodcont.2007.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lynch IT, Eustace JA, Plant WD, Cashman K.D, O’Keefe M, Lordan S, Moloney R. Inadequate Dietary Calcium and Vitamin D Intakes in Renal-Transplant Recipients in Ireland. J Ren Nutr 2007; 17:408-15. [DOI: 10.1053/j.jrn.2007.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Indexed: 11/11/2022] Open
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Abstract
It is well-established that prolonged and severe vitamin D deficiency leads to rickets in children and osteomalacia in adults. More marginal vitamin D deficiency is likely to be a significant contributing factor to osteoporosis risk. However, recent emerging data from studies of adults suggest that low vitamin D status (serum 25-hydroxyvitamin D levels <50 nmol/l) may be contributing to the development of various chronic diseases, including cardiovascular disease, hypertension, diabetes mellitus, some inflammatory and autoimmune diseases, and certain cancers. Adequacy of vitamin D status in children and adolescents has been the focus of a number of recent investigations, and these studies have shown a high prevalence of low vitamin D status during the winter (especially in adolescents), with lower prevalence during the summer. Therefore, consideration of potential corrective strategies to allow children and adolescents to maintain adequate vitamin D status throughout the year, even in the absence of adequate summer sun exposure, is warranted.
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Affiliation(s)
- Kevin D Cashman
- Department of Food and Nutritional Sciences, Department of Medicine, University College, Cork, Ireland.
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Cosgrove M, Flynn A, Kiely M. Impact of disaggregation of composite foods on estimates of intakes of meat and meat products in Irish adults. Public Health Nutr 2007; 8:327-37. [PMID: 15918931 DOI: 10.1079/phn2004692] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo evaluate the impact of the disaggregation of composite foods on intake estimates of meat and individual meat categories and on the contribution of meat to nutrient intakes in Irish adults.DesignData were analysed from the North/South Ireland Food Consumption Survey, which used a 7-day food diary to estimate food intake. Of 742 food codes that contained meat, 320 were codes for meat consumed as an individual portion and 422 were composite foods and were disaggregated to estimate the meat content.SubjectsA nationally representative sample of 475 men and 483 women (not pregnant or lactating) from the Republic of Ireland aged 18–64 years.ResultsThe mean intake of meat was 134 g day−1in consumers (98.5%) and men (168 g day−1) consumed significantly more (P< 0.001) than women (102 g day−1). Mean intakes of meat were higher in subjects with manual skilled occupations (P< 0.01) and lower in those with third-level educational qualifications (P< 0.05). Without disaggregating meat from composite foods, meat intake was overestimated by 43% (57 g day−1) and varied widely by meat category. Meat disaggregated from composite foods contributed 25% of meat intake. The contribution meat made to nutrient intakes ranged from 29% for protein, vitamin B12, zinc and niacin to 20% for vitamin D, 16% for vitamin B6, 15% for thiamine and 14% for iron.ConclusionsFailure to disaggregat meat from composite foods substantially overestimates meat intake, with a large variation between meat categories. This has important implications for estimates of meat intakes in nutritional epidemiological studies and for food safety purposes.
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Affiliation(s)
- Meadhbh Cosgrove
- Department of Food and Nutritional Sciences, University College Cork, Republic of Ireland
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Hill TR, O'Brien MM, Lamberg-Allardt C, Jakobsen J, Kiely M, Flynn A, Cashman KD. Vitamin D status of 51–75-year-old Irish women: its determinants and impact on biochemical indices of bone turnover. Public Health Nutr 2007; 9:225-33. [PMID: 16571177 DOI: 10.1079/phn2005837] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectivesTo assess the vitamin D status of Irish postmenopausal women during wintertime, and to examine its relationship with serum parathyroid hormone (PTH) and biochemical markers of bone turnover. In addition, the determinants of wintertime serum 25-hydroxyvitamin D (25OH–D) levels in these women were investigated.DesignA cross-sectional observational study.SettingCork City, Ireland (52°N).SubjectsNinety-five apparently healthy, free-living postmenopausal women (aged 51–75 years), not taking any medication and free from any condition likely to affect vitamin D status or calcium/bone metabolism.ResultsForty-eight per cent and 7% of women had serum 25OH–D levels <50 nmol l−1and <25 nmol l−1, respectively. 25OH–D levels in these women were positively associated with dietary calcium intake (P= 0.0002) and use of vitamin D-containing supplements (P= 0.031), and negatively associated with cigarette smoking (P= 0.027) and body mass index (BMI) (P= 0.030). Low serum 25OH-D levels (<50 nmol l−1) were associated (P<0.01) with elevated serum PTH levels. There were no significant differences in urinary pyridinium crosslinks or serum osteocalcin, biochemical indices of bone turnover, between subjects with serum 25OH–D levels above or below 50 nmol l−1.ConclusionsA high proportion of Irish postmenopausal women had low vitamin D status (< 50 nmol l−1) during late wintertime, which appeared to lead to elevated levels of serum PTH but not of bone turnover markers. Use of regular low-dose supplemental vitamin D, meeting daily calcium recommendations, cessation of smoking and maintaining BMI in the normal range are important factors that could help maintain adequate vitamin D levels during wintertime in these women.
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Affiliation(s)
- Tom R Hill
- Department of Food and Nutritional Sciences, University College, Cork, Ireland
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