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Pasco JA, Anderson KB, Williams LJ, Stuart AL, Hyde NK, Holloway-Kew KL. Dietary Intakes of Copper and Selenium in Association with Bone Mineral Density. Nutrients 2024; 16:2777. [PMID: 39203913 PMCID: PMC11356785 DOI: 10.3390/nu16162777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
The important trace elements, copper and selenium, have diverse effects on human health. As well as other important roles in living tissues, these trace elements are toxic at high levels but are key constituents of various enzymes and proteins essential for maintaining physiological health. However, links between dietary intakes of these elements, particularly copper, and bone mineral density (BMD) in humans remain uncertain. This study aimed to investigate whether dietary intakes of copper and selenium are associated with BMD in women. Dietary intakes of copper and selenium were assessed for 575 women in the Geelong Osteoporosis Study, using a detailed semi-quantitative food frequency questionnaire in conjunction with nutrition composition databases. Participants taking oral multivitamin preparations were excluded from analyses; 522 participants (ages 20-88 y) met the eligibility criteria. BMD at multiple skeletal sites was measured by dual energy X-ray absorptiometry (Lunar DPX-L). Separate multivariable regression models were developed to identify associations between copper and selenium intakes and BMD, after adjustments for age, anthropometry, other dietary factors, medication use, and lifestyle factors. Median (interquartile range) daily intake for copper was 1.5 mg (1.2-1.9) and for selenium, 72 μg (57-90). Low intakes (lowest tertile versus pooled upper tertiles) of copper and selenium were consistently associated with lower BMD at multiple skeletal sites. Fully adjusted models identified small but statistically significant differences in BMD, ranging from 1.8% to 4.0% for low copper intakes and 1.4% to 4.0% for low selenium intakes. Low dietary intakes of copper and selenium were both independently associated with lower BMD, at least in this sample of women. The results contribute to the evidence base for informing dietary recommendations for these trace elements with respect to their contributions to optimal bone health.
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Affiliation(s)
- Julie A. Pasco
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (K.B.A.); (L.J.W.); (A.L.S.); (N.K.H.); (K.L.H.-K.)
- Department of Medicine–Western Health, The University of Melbourne, St Albans, VIC 3021, Australia
- Department of Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Kara B. Anderson
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (K.B.A.); (L.J.W.); (A.L.S.); (N.K.H.); (K.L.H.-K.)
| | - Lana J. Williams
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (K.B.A.); (L.J.W.); (A.L.S.); (N.K.H.); (K.L.H.-K.)
| | - Amanda L. Stuart
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (K.B.A.); (L.J.W.); (A.L.S.); (N.K.H.); (K.L.H.-K.)
| | - Natalia K. Hyde
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (K.B.A.); (L.J.W.); (A.L.S.); (N.K.H.); (K.L.H.-K.)
| | - Kara L. Holloway-Kew
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, VIC 3220, Australia; (K.B.A.); (L.J.W.); (A.L.S.); (N.K.H.); (K.L.H.-K.)
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Aslam H, Mohebbi M, Ruusunen A, Dawson SL, Williams LJ, Berk M, Holloway-Kew KL, Collier F, Loughman A, Pasco JA, Jacka FN. Associations between dairy consumption and constipation in adults: A cross-sectional study. Nutr Health 2021; 28:31-39. [PMID: 33827333 DOI: 10.1177/02601060211004784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The current study aimed to assess the association between dairy consumption and constipation in the general adult population. DESIGN Data from the Geelong Osteoporosis Study were used to assess the association between dairy consumption and constipation in women (n=632) and men (n=609). Information on milk, yogurt and cheese, and constipation were self-reported. Total dairy was calculated by summing the intake of milk, yogurt and cheese and expressed as servings per day. Multivariable logistic regression models adjusted for irritable bowel syndrome, major depressive disorders, mobility, body mass index, age and fibre intake were used to examine the odds ratio (OR) and 95% confidence interval (CI) between the consumption of categories of total dairy, milk, yogurt, cheese, and constipation. RESULTS In women, consumption of 1-2 servings/d of total dairy was associated with reduced odds for constipation (OR: 0.49; 95% CI: 0.26-0.90; P=0.021) compared to consuming <1 serving/d of total dairy after adjusting for covariates. Also, consumption of 1-4 servings/d of milk was associated with marginally reduced odds for constipation (OR: 0.63; 95% CI: 0.39-1.02; P=0.058) compared to women who consumed <1 serving/d of milk after adjusting for covariates. There were no significant associations detected between other types of dairy consumption and constipation in women, and none in men. CONCLUSION In women, consumption of moderate amounts of dairy is associated with reduced odds for constipation whereas in men no associations were detected between dairy consumption and constipation. Further studies are warranted to confirm results.
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Affiliation(s)
- Hajara Aslam
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia
| | | | - Anu Ruusunen
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia.,Department of Psychiatry, Kuopio University Hospital, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Samantha L Dawson
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia.,Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Australia
| | - Lana J Williams
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia
| | - Michael Berk
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia.,Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health Department, Orygen, The Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia
| | - Kara L Holloway-Kew
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia
| | - Fiona Collier
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia.,Barwon Health, Australia.,Geelong Centre for Emerging Infectious Disease, Australia
| | - Amy Loughman
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia
| | - Julie A Pasco
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia.,Barwon Health, Australia.,Department of Medicine - Western Health, The University of Melbourne, Australia.,Joint senior Authors
| | - Felice N Jacka
- 98475Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Australia.,Black Dog Institute, Australia.,Joint senior Authors
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Whitbread JS, Murphy KJ, Clifton PM, Keogh JB. Iodine Excretion and Intake in Women of Reproductive Age in South Australia Eating Plant-Based and Omnivore Diets: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073547. [PMID: 33805502 PMCID: PMC8037805 DOI: 10.3390/ijerph18073547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022]
Abstract
Women consuming a strictly vegan/plant-based diet may be at increased risk of low iodine intake due to avoidance of animal products containing iodine. The aim of this pilot study was to determine the iodine excretion and intake in women consuming vegan/plant based diets compared with women consuming omnivore diets. Fifty-seven women (n = 31 plant-based, n = 26 omnivores), provided two spot urine samples to assess urinary iodine concentration (UIC). Two days of dietary intake were also recorded by participants. As the data were not normally distributed results are reported as median (IQR). UIC was significantly different between groups, 44 (26-66) µg/L in the vegan/plant-based group versus 64 (40-88) µg/L in omnivores (p < 0.05). UIC did not meet the >100 µg/L level recommended by the World Health Organization. Iodine intake was also significantly different, 78 (62-91) µg/day in the vegan/plant-based group and 125 (86-175) µg/day in the omnivores (p = 0.000). Iodine intake and bread intake were correlated with iodine excretion (CC 0.410-4.11, p = 0.003). These data indicate iodine insufficiency in both groups of women as the median values were below the minimum WHO recommendation. A larger study assessing iodine excretion in the Australian women of reproductive age who are not pregnant or breastfeeding is needed to confirm these findings.
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Rouf A, Nour M, Allman-Farinelli M. Improving Calcium Knowledge and Intake in Young Adults Via Social Media and Text Messages: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16499. [PMID: 32044755 PMCID: PMC7055802 DOI: 10.2196/16499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterized as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth. OBJECTIVE The aim of the CAlcium Nutrition-Dietary Opportunities (CAN-DO) study was to conduct a randomized controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake. METHODS The intervention was a 3-arm parallel trial. Young adults aged 18 to 25 years were recruited through university and social media for a 6-week trial. Participants were randomized to 1 of the 3 arms (ie, Facebook posts, Facebook posts plus text messages, and control group that received an electronic leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods, and secondary outcomes were knowledge, self-efficacy, motivation, and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention, and the differences in change between groups were compared using multivariate regression models with multiple imputations for missing data. RESULTS A total of 211 participants (64/211, 30.3% males) participated (mean age 21.4 years, SD 2.1) in this study. At the end of the program, no increase in milk intake (odds ratio [OR] 1.51, 95% CI 0.61-3.75 Facebook; OR 1.77, 95% CI 0.74-4.24 Facebook plus text messages; P=.41) nor calcium-rich food was detected (P=.57). There was a significant improvement in knowledge in the Facebook plus text messages group (P<.001), but habit formation improved less than that in the other 2 groups (P=.01). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants. CONCLUSIONS The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimize the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620000097943; http://www.anzctr.org.au/ACTRN12620000097943.aspx.
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Affiliation(s)
- Anika Rouf
- The University of Sydney, School of Life and Environmental Sciences, Camperdown, Australia
| | - Monica Nour
- The University of Sydney, School of Life and Environmental Sciences, Camperdown, Australia
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Aslam H, Holloway-Kew KL, Mohebbi M, Jacka FN, Pasco JA. Association between dairy intake and fracture in an Australian-based cohort of women: a prospective study. BMJ Open 2019; 9:e031594. [PMID: 31753881 PMCID: PMC6887043 DOI: 10.1136/bmjopen-2019-031594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Given the inconsistent evidence on dairy consumption and risk of fracture, we assessed the association between milk/total dairy consumption and major osteoporotic fracture (MOF) in women from the Geelong Osteoporosis Study (GOS). METHODS Women aged ≥50 years (n=833) were followed from baseline (1993-1997) to date of first fracture, death or 31 December 2017, whichever occurred first. Dairy consumption was assessed by self-report at baseline and the follow-up phases. MOFs (hip, forearm, clinical spine and proximal humerus) were confirmed radiologically. Multivariable-adjusted Cox proportional hazard models were used to determine associations between milk/total dairy (milk, cheese, yoghurt, ice cream) consumption and MOFs. Cross-sectional associations between milk/total dairy consumption and serum high-sensitivity C reactive protein (hsCRP), C-terminal telopeptide (CTx) and procollagen type 1 N-terminal propeptide (P1NP) at baseline were investigated using multivariable linear regression. RESULTS During follow-up (11 507 person-years), 206 women had an MOF. Consuming >500 mL/d of milk was not significantly associated with increased HR for MOF. Non-milk (1.56; 95% CI 0.99 to 2.46) drinkers and consumption of ≥800 g/d total dairy (1.70; 95% CI 0.99 to 2.93) had marginally higher HR for MOF compared with consuming <250 mL/d of milk and 200-399 g/d of total dairy, respectively. Milk consumption was inversely associated with serum hsCRP and CTx, but total dairy consumption was not associated with these serum markers. CONCLUSION Higher milk consumption did not increase the risk for MOF in older women. However, a trend for increased MOF was detected in zero milk and higher total dairy consuming women.
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Affiliation(s)
- Hajara Aslam
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
| | - Kara L Holloway-Kew
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health,Biostatistics Unit, Deakin University, Burwood, Victoria, Australia
| | - Felice N Jacka
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Black Dog Institute, Sydney, New South Wales, Australia
| | - Julie A Pasco
- School of Medicine, IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Department of Medicine, Western Campus, The University of Melbourne, St Albans, New South Wales, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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Jafari-Sfidvajani S, Ahangari R, Hozoori M, Mozaffari-Khosravi H, Fallahzadeh H, Nadjarzadeh A. The effect of vitamin D supplementation in combination with low-calorie diet on anthropometric indices and androgen hormones in women with polycystic ovary syndrome: a double-blind, randomized, placebo-controlled trial. J Endocrinol Invest 2018; 41:597-607. [PMID: 29110281 DOI: 10.1007/s40618-017-0785-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/25/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is known as the most common endocrine disorder in reproductive age women. The aim of this studywas to evaluate the effects of vitamin D supplementation in combination with low-calorie diet on anthropometric indices, reproductive hormones and menstrual regularity in overweight and obese PCOS women. METHODS In this randomized controlled clinical trial, 60 PCOS women with vitamin D insufficiency were randomly assigned to 12 weeks of either (1) weight-loss intervention + 50,000 IU/week oral vitamin D3 or (2) weight-loss intervention + placebo. At the beginning and end of the study, the anthropometric indices, body composition, 25-hydroxyvitamin D, total testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG) and free androgen index (FAI) were measured and regularity of menses was compared among the two groups. RESULT After 12-week intervention, median of serum 25-hydroxyvitamin D3 significantly increased from 18.5 (10.75-20) ng/ml to 42.69 (34-53.25) ng/ml in vitamin D group compared to placebo group (p < 001). Moreover, there was a significant improvement in frequency regular menstrual cycle (p = 0.01). Mean of weight, body mass index, fat mass, waist and hip circumference and waist-to-hip ratio significantly decreased in both groups, but was not different between two groups. Mean of total testosterone insignificantly decreased from 0.7 to 0.5 ng/ml in vitamin D group (p = 0.18). In addition, we did not observe significant differences regarding DHEAS, FAI and SHBG between two groups. CONCLUSIONS In women with PCOS, androgen profile did not change with vitamin D supplementation when combined with low-calorie diet, but menstrual frequency significantly improved. CLINICAL TRIAL REGISTRATION NUMBER IRCT2016062710826N19.
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Affiliation(s)
- S Jafari-Sfidvajani
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - R Ahangari
- Obstetric and Gynecology Department, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - M Hozoori
- Nutritional Community Medicine Qom University of Medical Sciences, Qom, Iran
| | - H Mozaffari-Khosravi
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Diabetic Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - H Fallahzadeh
- Research Center for Prevention and Epidemiology of Non-communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A Nadjarzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Abstract
PURPOSE OF REVIEW In addition to the actions of the endocrine hormone, 1alpha,25-dihydroxyvitamin D (1,25(OH)2D) in stimulating intestinal calcium absorption, the regulation of bone mineral metabolism by 1,25(OH)2D is also considered an important contributor to calcium homeostasis. However, recent evidence suggest that 1,25(OH)2D acting either via endocrine or autocrine pathways plays varied roles in bone, which suggests that vitamin D contributes to the maintenance of bone mineral in addition to its catabolic roles. This review highlights the contrasting evidence for the direct action for vitamin D metabolism and activity in bone. RECENT FINDINGS Numerous cells within bone express vitamin D receptor (VDR), synthesise and catabolise 1,25(OH)2D via 25-hydroxyvitamin D 1alpha-hydroxylase (CYP27B1), and 25-hydroxyvitamin D 24-hydroxylase (CYP24A1) enzymes, respectively. Recent evidence suggests that all three genes are required to regulate processes of bone resorption, mineralization and fracture repair. The actions of vitamin D in bone appear to negatively or positively regulate bone mineral depending on the physiological and pathological circumstances, suggesting that vitamin D plays pleiotropic roles in bone.
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Affiliation(s)
- Paul H Anderson
- Musculoskeletal Biology Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia.
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Ong AM, Weiler HA, Wall M, Goltzman D, Whiting SJ, Daskalopoulou SS, Morin SN. A 51-item calcium-focused food frequency questionnaire is a reliable tool to assess dietary calcium intake in postmenopausal women. Nutr Res 2017; 43:33-42. [DOI: 10.1016/j.nutres.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/16/2022]
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Qatatsheh A, Tayyem R, Al-Shami I, Al-Holy MA, Al-rethaia AS. Vitamin D deficiency among Jordanian university students and employees. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/nfs-01-2014-0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– This paper aims to assess the prevalence of vitamin D deficiency among female university students and employees at the Hashemite University (HU) and, then, to identify risk factors for developing vitamin D deficiency among this population. Vitamin D deficiency remains widespread in many countries, including Jordan, and has been linked to many diseases.
Design/methodology/approach
– In this cross-sectional study, blood samples were taken from 320 healthy females – 160 students and 160 employees – aged between 18 and 65 years old who presented for routine checkup at the medical center of HU. Level of direct sun exposure and barriers to getting enough sunlight (dress style, skin color and sunscreen use) were questioned. Serum levels of 25-hydroxyvitamin D were measured, and the daily intakes of vitamin D, calcium and phosphorous were estimated through completing an adopted food frequency questionnaire. All required data were collected using a face-to-face interview by trained dietitians. The software package ESHA was used to determine the daily intake from the nutrients.
Findings
– The prevalence of vitamin D deficiency (25-OHD < 25 nmol/L) was 31.2 per cent in female students compared to 20.5 per cent in female employees. Prolonged exposure to sun was independently related to vitamin D deficiency (odds ratio = 4.55); participants exposed for 30 minutes daily were at a higher risk for vitamin D deficiency. However, estimated vitamin D intake was not affected by age and working status.
Research limitations/implications
– The present study has some important limitations. First, this study based on serum 25-OHD results, which alone, without biochemical parameters such as parathyroid hormone (either primary or secondary), might be linked to accelerated degradation of 25-OHD and shorter half-life. Second, the half-life of 25-OHD was not consistently available. Third, the smaller sample size of participants. Finally, the present study did not distinguish between intake of vitamin D2 and D3. This limitation caused the inability to precisely evaluate the prevalence of vitamin D deficiency in the studied population.
Practical implications
– This study indicates that it is crucial to create awareness concerning the daily intake of vitamin D in the community to avoid long-term complications related to vitamin D deficiency, by using urgent measures including vitamin D supplementation and fortification of some highly consumed food, milk and other dairy products. Educational endeavors about sensible sun exposure should be implemented to improve vitamin D status among this population. The findings of the present study call for action at the national level to build strategies for health promotion about vitamin D supplementation in groups at risk for low supplementation (e.g. younger female students, with previous chronic diseases and poor sun exposure), and engage these populations in strategizing for successful and demographically relevant outreach and education in their own communities along with effort to prevent obesity and diabetes as well as raising awareness through simple programs to prevent and treat vitamin D deficiency among women living in Jordan.
Originality/value
– The high prevalence of vitamin D deficiency among female university students in this study emphasizes the necessity of vitamin D supplementation and calls for action to build strategies for health promotion concerning vitamin D supplementation.
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust 2015; 199:S1-S46. [PMID: 25370432 DOI: 10.5694/j.1326-5377.2013.tb04225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/02/2012] [Indexed: 12/14/2022]
Abstract
Osteoporosis imposes a tremendous burden on Australia: 1.2 million Australians have osteoporosis and 6.3 million have osteopenia. In the 2007–08 financial year, 82 000 Australians suffered fragility fractures, of which > 17 000 were hip fractures. In the 2000–01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions — to ensure people have adequate calcium intake, vitamin D levels and appropriate physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, muscle strengthening exercises and challenging balance/mobility activities should be conducted in a safe environment.
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Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC, Australia.
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Gagnon C, Daly RM, Carpentier A, Lu ZX, Shore-Lorenti C, Sikaris K, Jean S, Ebeling PR. Effects of combined calcium and vitamin D supplementation on insulin secretion, insulin sensitivity and β-cell function in multi-ethnic vitamin D-deficient adults at risk for type 2 diabetes: a pilot randomized, placebo-controlled trial. PLoS One 2014; 9:e109607. [PMID: 25299668 PMCID: PMC4192133 DOI: 10.1371/journal.pone.0109607] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/30/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To examine whether combined vitamin D and calcium supplementation improves insulin sensitivity, insulin secretion, β-cell function, inflammation and metabolic markers. DESIGN 6-month randomized, placebo-controlled trial. PARTICIPANTS Ninety-five adults with serum 25-hydroxyvitamin D [25(OH)D] ≤55 nmol/L at risk of type 2 diabetes (with prediabetes or an AUSDRISK score ≥15) were randomized. Analyses included participants who completed the baseline and final visits (treatment n = 35; placebo n = 45). INTERVENTION Daily calcium carbonate (1,200 mg) and cholecalciferol [2,000-6,000 IU to target 25(OH)D >75 nmol/L] or matching placebos for 6 months. MEASUREMENTS Insulin sensitivity (HOMA2%S, Matsuda index), insulin secretion (insulinogenic index, area under the curve (AUC) for C-peptide) and β-cell function (Matsuda index x AUC for C-peptide) derived from a 75 g 2-h OGTT; anthropometry; blood pressure; lipid profile; hs-CRP; TNF-α; IL-6; adiponectin; total and undercarboxylated osteocalcin. RESULTS Participants were middle-aged adults (mean age 54 years; 69% Europid) at risk of type 2 diabetes (48% with prediabetes). Compliance was >80% for calcium and vitamin D. Mean serum 25(OH)D concentration increased from 48 to 95 nmol/L in the treatment group (91% achieved >75 nmol/L), but remained unchanged in controls. There were no significant changes in insulin sensitivity, insulin secretion and β-cell function, or in inflammatory and metabolic markers between or within the groups, before or after adjustment for potential confounders including waist circumference and season of recruitment. In a post hoc analysis restricted to participants with prediabetes, a significant beneficial effect of vitamin D and calcium supplementation on insulin sensitivity (HOMA%S and Matsuda) was observed. CONCLUSIONS Daily vitamin D and calcium supplementation for 6 months may not change OGTT-derived measures of insulin sensitivity, insulin secretion and β-cell function in multi-ethnic adults with low vitamin D status at risk of type 2 diabetes. However, in participants with prediabetes, supplementation with vitamin D and calcium may improve insulin sensitivity. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12609000043235.
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Affiliation(s)
- Claudia Gagnon
- Department of Medicine, NorthWest Academic Centre, The University of Melbourne, Western Health, Melbourne, Australia
- * E-mail:
| | - Robin M. Daly
- Department of Medicine, NorthWest Academic Centre, The University of Melbourne, Western Health, Melbourne, Australia
| | - André Carpentier
- Department of Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Zhong X. Lu
- Melbourne Pathology, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Catherine Shore-Lorenti
- Department of Medicine, NorthWest Academic Centre, The University of Melbourne, Western Health, Melbourne, Australia
| | | | - Sonia Jean
- Department of Chronic Diseases Surveillance, Institut national de santé publique du Québec, Quebec City, Canada
- Department of Medicine, Laval University, Quebec City, Canada
| | - Peter R. Ebeling
- Department of Medicine, NorthWest Academic Centre, The University of Melbourne, Western Health, Melbourne, Australia
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Acute and 3-month effects of microcrystalline hydroxyapatite, calcium citrate and calcium carbonate on serum calcium and markers of bone turnover: a randomised controlled trial in postmenopausal women. Br J Nutr 2014; 112:1611-20. [PMID: 25274192 DOI: 10.1017/s0007114514002785] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ca supplements are used for bone health; however, they have been associated with increased cardiovascular risk, which may relate to their acute effects on serum Ca concentrations. Microcrystalline hydroxyapatite (MCH) could affect serum Ca concentrations less than conventional Ca supplements, but its effects on bone turnover are unclear. In the present study, we compared the acute and 3-month effects of MCH with conventional Ca supplements on concentrations of serum Ca, phosphate, parathyroid hormone and bone turnover markers. We randomised 100 women (mean age 71 years) to 1 g/d of Ca as citrate or carbonate (citrate-carbonate), one of two MCH preparations, or a placebo. Blood was sampled for 8 h after the first dose, and after 3 months of daily supplementation. To determine whether the acute effects changed over time, eight participants assigned to the citrate dose repeated 8 h of blood sampling at 3 months. There were no differences between the citrate and carbonate groups, or between the two MCH groups, so their results were pooled. The citrate-carbonate dose increased ionised and total Ca concentrations for up to 8 h, and this was not diminished after 3 months. MCH increased ionised Ca concentrations less than the citrate-carbonate dose; however, it raised the concentrations of phosphate and the Ca-phosphate product. The citrate-carbonate and MCH doses produced comparable decreases in bone resorption (measured as serum C-telopeptide (CTX)) over 8 h and bone turnover (CTX and procollagen type-I N-terminal propeptide) at 3 months. These findings suggest that Ca preparations, in general, produce repeated sustained increases in serum Ca concentrations after ingestion of each dose and that Ca supplements with smaller effects on serum Ca concentrations may have equivalent efficacy in suppressing bone turnover.
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Abstract
OBJECTIVE To identify and critique tools for the assessment of Ca and/or dairy intake in adults, in order to ascertain the most accurate and reliable tools available. DESIGN A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles reporting on originally developed tools or testing the reliability or validity of existing tools that measure Ca and/or dairy intake in adults were included. Author-defined criteria for reporting reliability and validity properties were applied. SETTING Studies conducted in Western countries. SUBJECTS Adults. RESULTS Thirty papers, utilising thirty-six tools assessing intake of dairy, Ca or both, were identified. Reliability testing was conducted on only two dairy and five Ca tools, with results indicating that only one dairy and two Ca tools were reliable. Validity testing was conducted for all but four Ca-only tools. There was high reliance in validity testing on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful differences. Results of the validity testing suggest one dairy and five Ca tools are valid. Thus one tool was considered both reliable and valid for the assessment of dairy intake and only two tools proved reliable and valid for the assessment of Ca intake. CONCLUSIONS While several tools are reliable and valid, their application across adult populations is limited by the populations in which they were tested. These results indicate a need for tools that assess Ca and/or dairy intake in adults to be rigorously tested for reliability and validity.
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence‐informed strategy to prevent osteoporosis in Australia. Med J Aust 2013. [DOI: 10.5694/mjao12.11363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD
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Evidence for the treatment of osteoporosis with vitamin D in residential care and in the community dwelling elderly. BIOMED RESEARCH INTERNATIONAL 2013; 2013:463589. [PMID: 24058907 PMCID: PMC3766590 DOI: 10.1155/2013/463589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/12/2013] [Indexed: 12/31/2022]
Abstract
Introduction. Vitamin D is common treatment for osteoporosis. Both age >70 years and living in residential care are associated with increased fracture risk. Community dwelling elderly are a heterogeneous group who may have more similatiry with residential care groups than younger community dwelling counterparts. Aims. To review the evidence for cholecalciferol or ergocalciferol tretment of osteoporosis in either community dwelling patients aged ≥70 years of age, or redidential care patients. Secondly endpoints were changes in bone mineral denisty, and in bone turnover markers. Methods. We performed a literature search using search terms for osteoporosis and vitamin D. Treatment for at least one year was required. Results. Only one residential care study using cholecalciferol, showed non-vertebral and hip fracture reduction in vitamin D deficient subjects. In the community setting one quasi randomised study using ergocalciferol showed reduction in total but not hip or non-vertebral fracture, and a second randomised study showed increased hip fracture risk. Three studies reported increases in hip bone mineral denisty. Discussion. A minority of studies demonstrated a fracture benefit form vitamin D and one suggested possible harm in a community setting. Current practice should be to only offer this treatment to subjects identified as deficient.
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16
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Brennan SL, Winzenberg TM, Pasco JA, Wluka AE, Dobbins AG, Jones G. Social disadvantage, bone mineral density and vertebral wedge deformities in the Tasmanian Older Adult Cohort. Osteoporos Int 2013; 24:1909-16. [PMID: 23229468 DOI: 10.1007/s00198-012-2211-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED The relationship between social disadvantage and bone mineral density (BMD) is complex and remains unclear; furthermore, little is known of the relationship with vertebral deformities. We observed social disadvantage to be associated with BMD for females, independent of body mass index (BMI). A lower prevalence of vertebral deformities was observed for disadvantaged males. INTRODUCTION The relationship between social disadvantage and BMD appears complex and remains unclear, and little is known about the association between social disadvantage and vertebral wedge deformities. We examined the relationship between social disadvantage, BMD and wedge deformities in older adults from the Tasmanian Older Adult Cohort. METHODS BMD and wedge deformities were measured by dual-energy X-ray absorptiometry and associations with extreme social disadvantage was examined in 1,074 randomly recruited population-based adults (51 % female). Socioeconomic status was assessed by Socio-economic Indexes for Areas values derived from residential addresses using Australian Bureau of Statistics 2001 census data. Lifestyle variables were collected by self-report. Regression models were adjusted for age, BMI, dietary calcium, serum vitamin D (25(OH)D), smoking, alcohol, physical inactivity, calcium/vitamin D supplements, glucocorticoids and hormone therapy (females only). RESULTS Compared with other males, socially disadvantaged males were older (65.9 years versus 61.9 years, p = 0.008) and consumed lower dietary calcium and alcohol (both p ≤ 0.03). Socially disadvantaged females had greater BMI (29.9 ± 5.9 versus 27.6 ± 5.3, p = 0.002) and consumed less alcohol (p = 0.003) compared with other females. Socially disadvantaged males had fewer wedge deformities compared with other males (33.3 % versus 45.4 %, p = 0.05). After adjustment, social disadvantage was negatively associated with hip BMD for females (p = 0.02), but not for males (p = 0.70), and showed a trend for fewer wedge deformities for males (p = 0.06) but no association for females (p = 0.85). CONCLUSIONS Social disadvantage appears to be associated with BMD for females, independent of BMI and other osteoporosis risk factors. A lower prevalence of vertebral deformities was observed for males of extreme social disadvantage. Further research is required to elucidate potential mechanisms for these associations.
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Affiliation(s)
- S L Brennan
- NorthWest Academic Centre, Department of Medicine, Sunshine Hospital, The University of Melbourne, 176 Furlong Road, St Albans, VIC 3021, Australia.
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17
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Hossain KG, Islam N, Jacob D, Ghavami F, Tucker M, Kowalski T, Leilani A, Zacharias J. Interdependence of Genotype and Growing Site on Seed Mineral Compositions in Common Bean. ASIAN JOURNAL OF PLANT SCIENCES 2013; 12:11-20. [PMID: 30271428 PMCID: PMC6159228 DOI: 10.3923/ajps.2013.11.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Essential minerals are considered as key determinants of optimum health and nutritive quality of common bean seed. This study aimed to identify genetically stable essential minerals in common bean. Eleven diverse common bean genotypes were grown in three distinct growing environments and 17 essential minerals were analyzed by Inductively Coupled Plasma-Optical Emission Spectroscopy. Genetic control of mineral composition in common bean seed was demonstrated by large (p<0.01) genotypic differences in Ca and Sr contents and moderate genotypic difference was observed in Fe content. Significant influence of genotype and environments (G×E) interaction was observed in the content of all minerals. The ratios between genetic and environmental variances and between genetic and G×E variances indicated the greater influence and stability of genetic factor on the concentration of Ca and Sr in common bean seed. Significant positive correlations among important minerals such as Zn with S, P, Fe and Na and Cu with K, Mg, Ni, P were identified. The stability of genetic effects on Ca and Sr concentration in common bean has been identified in this study. Calcium is one of the most important minerals which regulates many cellular processes and has important structural roles in living organisms. Further studies to characterize Ca physiology in common bean may identify genetic or biochemical markers to expedite breeding common bean with enhanced Ca concentration.
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Affiliation(s)
- K G Hossain
- Mayville State University, Mayville, North Dakota, United States
| | - N Islam
- University of Maryland College Park, MD, United States
| | - D Jacob
- North Dakota State University, Fargo, North Dakota, United States
| | - F Ghavami
- North Dakota State University, Fargo, North Dakota, United States
| | - M Tucker
- Mayville State University, Mayville, North Dakota, United States
| | - T Kowalski
- Mayville State University, Mayville, North Dakota, United States
| | - A Leilani
- Mayville State University, Mayville, North Dakota, United States
| | - J Zacharias
- Mayville State University, Mayville, North Dakota, United States
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18
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Pasco JA, Nicholson GC, Kotowicz MA. Cohort Profile: Geelong Osteoporosis Study. Int J Epidemiol 2011; 41:1565-75. [PMID: 23283714 DOI: 10.1093/ije/dyr148] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Julie A Pasco
- School of Medicine, Deakin University, Geelong, Victoria, Australia.
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19
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Henry MJ, Pasco JA, Nicholson GC, Kotowicz MA. Prevalence of osteoporosis in Australian men and women: Geelong Osteoporosis Study. Med J Aust 2011; 195:321-2. [DOI: 10.5694/mja11.10571] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/01/2011] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Geoff C Nicholson
- Rural Clinical School, School of Medicine, University of Queensland, Toowoomba, QLD
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20
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Pasco JA, Brennan SL, Henry MJ, Nicholson GC, Sanders KM, Zhang Y, Kotowicz MA. Changes in hip fracture rates in southeastern Australia spanning the period 1994-2007. J Bone Miner Res 2011; 26:1648-54. [PMID: 21445981 DOI: 10.1002/jbmr.393] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Hip fracture incidence rates appear to be declining in Western populations. Utilizing comprehensive incident hip fracture data from radiology reports, we determined changes in hip fracture rates in southeastern Australia between 1994-1996 and 2006-2007 for residents aged 55 years or older. During this period, the population at risk increased by 47% for men and 40% for women. Although the absolute number of hip fractures increased by 53% in men and 4.4% in women, standardized hip fracture ratios were 0.92 [95% confidence interval (CI) 0.79-1.08] and 0.69 (95% CI 0.62-0.77), respectively. Marked reductions in hip fracture rates were observed for women: 32% for ages 75 to 84 years and 29% for ages 85 years or older. Data from the Geelong Osteoporosis Study were used to identify changes in body composition and lifestyle that might have influenced hip fracture risk in women during this period. Between 1993-1997 and 2004-2008, there was an increase in adiposity, bone mineral density (BMD), healthy lifestyles, and exposure to bone-active drugs; use of hormone therapy declined. Thus hip fracture incidence rates have decreased from the mid-1990 s to the mid-2000 s, the effect being greater among women. Our data also suggest that the recent increase in adiposity and consequent increase in BMD at the hip may have contributed to this decline. However, improved efficacy and increased uptake of antifracture drug treatments, other cohort effects, or other environmental influences cannot be excluded.
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Affiliation(s)
- Julie A Pasco
- Epidemiology and Biostatistics Unit, Barwon Health, School of Medicine, Deakin University, Geelong, Victoria, Australia.
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21
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Hung A, Hamidi M, Riazantseva E, Thompson L, Tile L, Tomlinson G, Stewart B, Cheung AM. Validation of a calcium assessment tool in postmenopausal Canadian women. Maturitas 2011; 69:168-72. [DOI: 10.1016/j.maturitas.2011.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 02/18/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
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Williams LJ, Pasco JA, Henry MJ, Sanders KM, Nicholson GC, Kotowicz MA, Berk M. Paracetamol (acetaminophen) use, fracture and bone mineral density. Bone 2011; 48:1277-81. [PMID: 21396491 DOI: 10.1016/j.bone.2011.03.435] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 02/15/2011] [Accepted: 03/02/2011] [Indexed: 01/02/2023]
Abstract
Paracetamol is the most widely prescribed simple analgesic and antipyretic. It exerts its effects via cyclooxygenase and endocannabinoid pathways, which may affect signalling in bone cells and hence influence bone metabolism. Given the high rates of paracetamol use in the community and the evidence linking its mechanism of action to bone metabolism, we aimed to investigate the association between paracetamol use, fracture, and bone mineral density (BMD) in women participating in the Geelong Osteoporosis Study (GOS). Cases (n = 569) were women aged ≥ 50 years identified from radiological reports as having sustained a fracture between 1994 and 1996. Controls (n = 775) were women without fracture recruited from the same region during this period. BMD was measured at the spine, hip, total body and forearm using dual energy absorptiometry. Medication use, medical history and lifestyle factors were self-reported. There were 69 (12.1%) paracetamol users among the cases and 63 (8.1%) among the controls. Paracetamol use increased the odds for fracture (OR = 1.56, 95%CI 1.09-2.24, p = 0.02). Adjustment for BMD at the spine, total hip and forearm did not confound the association. However, incorporating total body BMD into the model attenuated the association (adjusted OR = 1.46, 95%CI 1.00-2.14, p = 0.051). Further adjustment for age, weight, physical activity, smoking, alcohol, calcium intake, medication use, medical conditions, falls and previous fracture did not explain the association. These data suggest that paracetamol use is a risk factor for fracture, although the mechanism of action remains unclear.
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Affiliation(s)
- Lana J Williams
- School of Medicine, Deakin University, Australia; Department of Psychiatry, University of Melbourne, Australia.
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23
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Brennan SL, Henry MJ, Kotowicz MA, Nicholson GC, Zhang Y, Pasco JA. Incident hip fracture and social disadvantage in an Australian population aged 50 years or greater. Bone 2011; 48:607-10. [PMID: 21040808 DOI: 10.1016/j.bone.2010.10.175] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/07/2010] [Accepted: 10/24/2010] [Indexed: 11/25/2022]
Abstract
AIMS There is an inverse association between socioeconomic status (SES) and most causes of morbidity. Hip fractures pose a significant public health burden on society. However, the association between quintiles of area-based SES and incident hip fractures has not been examined in Australia. Using a comprehensive register of hip fractures for the entire Barwon Statistical Division (BSD), we assessed the association between area-based SES and incident hip fractures over a two-year period in residents aged ≥ 50years. METHODS Incident hip fractures were identified using a computerized keyword search of all radiological reports from all the radiological centers serving the BSD. Pathological fractures were excluded. SES was determined by cross-referencing residential addresses with Australian Bureau of Statistics census data and categorized in quintiles based upon the BSD reference range. Homogeneity of population at risk in each SES quintile was tested using chi square comparison. Hip fractures in each quintile and within each age strata for the entire BSD region were defined as rates per 1000 person-years. RESULTS During 2006-2007, there were 495 hip fractures (336 female). An inverse pattern of association was observed between SES and hip fracture incidence, with a peak in fracture numbers observed in the second quintile of SES, with differences between SES quintiles observed for both females (p = 0.005) and males (p = 0.007). CONCLUSION The association between incident hip fractures and quintiles of area-based SES provides evidence that those of greater social disadvantage should be a specific target population for intervention to reduce the burden of hip fracture within Australia.
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Affiliation(s)
- S L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne 3004, Australia.
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Habitual physical activity and the risk for depressive and anxiety disorders among older men and women. Int Psychogeriatr 2011; 23:292-8. [PMID: 20863424 DOI: 10.1017/s1041610210001833] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Regular physical activity is generally associated with psychological well-being, although there are relatively few prospective studies in older adults. We investigated habitual physical activity as a risk factor for de novo depressive and anxiety disorders in older men and women from the general population. METHODS In this nested case-control study, subjects aged 60 years or more were identified from randomly selected cohorts being followed prospectively in the Geelong Osteoporosis Study. Cases were individuals with incident depressive or anxiety disorders, diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP); controls had no history of these disorders. Habitual physical activity, measured using a validated questionnaire, and other exposures were documented at baseline, approximately four years prior to psychiatric interviews. Those with depressive or anxiety disorders that pre-dated baseline were excluded. RESULTS Of 547 eligible subjects, 14 developed de novo depressive or anxiety disorders and were classified as cases; 533 controls remained free of disease. Physical activity was protective against the likelihood of depressive and anxiety disorders; OR = 0.55 (95% CI 0.32-0.94), p = 0.03; each standard deviation increase in the transformed physical activity score was associated with an approximate halving in the likelihood of developing depressive or anxiety disorders. Leisure-time physical activity contributed substantially to the overall physical activity score. Age, gender, smoking, alcohol consumption, weight and socioeconomic status did not substantially confound the association. CONCLUSION This study provides evidence consistent with the notion that higher levels of habitual physical activity are protective against the subsequent risk of development of de novo depressive and anxiety disorders.
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Miller M, Yeo YC, Khor MJ, Clover E, Magarey A. Repeatability of a short food frequency questionnaire to assess calcium intake in older australians. J Aging Res 2010; 2010:905056. [PMID: 21188231 PMCID: PMC3004202 DOI: 10.4061/2010/905056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/25/2010] [Accepted: 03/25/2010] [Indexed: 11/24/2022] Open
Abstract
Objective. To assess the repeatability of the validated Flinders Calcium Food Frequency Questionnaire (FFQCA)
for estimating dietary calcium intake in a sample of community dwelling older Australians. Methods. A test-retest repeatability study involving 100 subjects (≥65
years) living independently in metropolitan Adelaide, Australia. Estimates of daily calcium intake from the first (FFQCA1)
and repeated administration (FFQCA2)
were calculated from two versions (35-item and 15-item) of the FFQCA. The intraclass correlation coefficient (ICC) was used to assess the repeatability. Results. Moderate and comparable ICC values (r = 0.5, r = 0.6) were found across the two versions of the FFQCA. Conclusion. Both FFQCA versions demonstrated moderate repeatability, supporting the results of previous studies.
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Affiliation(s)
- Michelle Miller
- Nutrition and Dietetics, Clinical and Molecular Medicine, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
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Hollingworth SA, Gunanti I, Nissen LM, Duncan EL. Secondary prevention of osteoporosis in Australia: analysis of government-dispensed prescription data. Drugs Aging 2010; 27:255-64. [PMID: 20210370 DOI: 10.2165/11318400-000000000-00000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Osteoporosis is a common cause of disability and death in elderly men and women. Until 2007, Australian Government-subsidized use of oral bisphosphonates, raloxifene and calcitriol (1alpha,25-dihydroxycholecalciferol) was limited to secondary prevention (requiring x-ray evidence of previous low-trauma fracture). The cost to the Pharmaceutical Benefits Scheme was substantial (164 million Australian dollars in 2005/6). OBJECTIVE To examine the dispensed prescriptions for oral bisphosphonates, raloxifene, calcitriol and two calcium products for the secondary prevention of osteoporosis (after previous low-trauma fracture) in the Australian population. METHODS We analysed government data on prescriptions for oral bisphosphonates, raloxifene, calcitriol and two calcium products from 1995 to 2006, and by sex and age from 2002 to 2006. Prescription counts were converted to defined daily doses (DDD)/1000 population/day. This standardized drug utilization method used census population data, and adjusts for the effects of aging in the Australian population. RESULTS Total bisphosphonate use increased 460% from 2.19 to 12.26 DDD/1000 population/day between June 2000 and June 2006. The proportion of total bisphosphonate use in June 2006 was 75.1% alendronate, 24.6% risedronate and 0.3% etidronate. Raloxifene use in June 2006 was 1.32 DDD/1000 population/day. The weekly forms of alendronate and risedronate, introduced in 2001 and 2003, respectively, were quickly adopted. Bisphosphonate use peaked at age 80-89 years in females and 85-94 years in males, with 3-fold higher use in females than in males. CONCLUSIONS Pharmaceutical intervention for osteoporosis in Australia is increasing with most use in the elderly, the population at greatest risk of fracture. However, fracture prevalence in this population is considerably higher than prescribing of effective anti-osteoporosis medications, representing a missed opportunity for the quality use of medicines.
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Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Pasco JA. Socioeconomic status and bone mineral density in a population-based sample of men. Bone 2010; 46:993-9. [PMID: 20053386 DOI: 10.1016/j.bone.2009.12.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 11/05/2009] [Accepted: 12/23/2009] [Indexed: 11/22/2022]
Abstract
Overall, socioeconomic status (SES) is inversely associated with poorer health outcomes. However, current literature provides conflicting data of the relationship between SES and bone mineral density (BMD) in men. In an age-stratified population-based randomly selected cross-sectional study of men (n=1467) we assessed the association between SES and lifestyle exposures in relation to BMD. SES was determined by matching the residential address for each subject with Australian Bureau of Statistics 2006 census data for the study region. BMD was measured at the spine and femoral neck by dual energy X-ray absorptiometry. Lifestyle variables were collected by self-report. Regression models were age-stratified into younger and older groups and adjusted for age, weight, dietary calcium, physical activity, and medications known to affect bone. Subjects with spinal abnormalities were excluded from analyses of BMD at the spine. In younger men, BMD was highest at the spine in the mid quintiles of SES, where differences were observed compared to quintile 1 (1-7%, p<0.05). In older men, the pattern of BMD across SES quintiles was reversed, and subjects from mid quintiles had the lowest BMD, with differences observed compared to quintile 5 (1-7%, p<0.05). Differences in BMD at the spine across SES quintiles represent a potential 1.5-fold increase in fracture risk for those with the lowest BMD. There were no differences in BMD at the femoral neck. Further research is warranted which examines the mechanisms that may underpin differences in BMD across SES quintiles and to address the current paucity of data in this field of enquiry.
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Affiliation(s)
- Sharon L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
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Pasco JA, Henry MJ, Nicholson GC, Brennan SL, Kotowicz MA. Behavioural and physical characteristics associated with vitamin D status in women. Bone 2009; 44:1085-91. [PMID: 19264157 DOI: 10.1016/j.bone.2009.02.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/24/2008] [Accepted: 02/17/2009] [Indexed: 12/28/2022]
Abstract
For most people in Australia, the primary source of vitamin D is casual exposure to sunlight. Hypovitaminosis D has been reported for high-risk populations, but little has been documented for women of all ages living in the community. Using cross-sectional data, we aimed to describe physical and behavioural characteristics associated with serum 25-hydroxyvitamin D (25OHD) for such women and to determine the association of serum 25OHD with hypertension and bone health. Serum 25OHD, parathyroid hormone (PTH), blood pressure, bone mineral density (BMD) and anthropometry were measured in a random sample of 861 women aged 20-92 years enrolled in the Geelong Osteoporosis Study, set in a temperate region at latitude 38-39 degrees S. Lifestyle factors (including diet, smoking, medication use, socio-economic status, residence, education, occupation, and physical activity) were documented by questionnaire. In season-adjusted models for women aged 20-54 years, physical activity and living with a partner were independently and positively associated with serum 25OHD; associations with weight and waist-hip ratio were negative. Among older women, physical activity, vitamin D intake and urban dwelling were positively associated with serum 25OHD; age, weight and smoking were negative. Compared with the lowest tertile, those in the highest serum 25OHD tertile were less likely to have elevated serum PTH (adjusted OR=0.25, 95% CI 0.16-0.41) and high blood pressure (adjusted OR=0.40, 95% CI 0.22-0.72), and more likely to have normal hip and spine BMD (adjusted OR=1.65, 95% CI 1.08-2.52). In multivariable models adjusting for season, age, weight (and height), BMD was associated with serum 25OHD at the spine, hip and whole body; no associations were detected at the forearm and no other characteristics were identified as confounders. Factors associated with high vitamin D status generally reflected healthy body habitus and active lifestyles. In contrast, excessive weight and smoking were associated with poorer vitamin D status. Women with high vitamin D were less likely to have elevated PTH, hypertension or bone deficits than women with poor levels.
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Affiliation(s)
- Julie A Pasco
- Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Australia.
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Poliquin S, Joseph L, Gray-Donald K. Calcium and vitamin D intakes in an adult Canadian population. CAN J DIET PRACT RES 2009; 70:21-7. [PMID: 19261203 DOI: 10.3148/70.1.2009.21] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Calcium and vitamin D intakes from food and supplements were estimated in Canadian men and women. METHODS Calcium intakes from both diet and supplements and vitamin D intakes from fortified milk and supplements were estimated using cross-sectional data from 9423 randomly selected subjects aged 25 years or older, who were participating in a longitudinal study on osteoporosis. Subjects completed an abbreviated food frequency questionnaire administered by a trained interviewer between July 1995 and December 1997. RESULTS The mean (standard deviation) daily intake for calcium was estimated to be 1038 (614) mg for women and 904 (583) mg for men; for vitamin D, mean intakes were 5.6 (5.9) microg and 4.8 (5.5) microg for women and men, respectively. CONCLUSIONS Mean intakes for calcium and vitamin D in men and women under age 51 were close to the adequate daily intake levels. Older adults, however, may be at risk of deficiency.
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Affiliation(s)
- Suzette Poliquin
- CaMos Coordinating Centre, MUHC Research Institute, Royal Victoria Hospital, Montreal, QC
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Nguyen HTT, von Schoultz B, Pham DMT, Nguyen DB, Le QH, Nguyen DV, Hirschberg AL, Nguyen TV. Peak bone mineral density in Vietnamese women. Arch Osteoporos 2009; 4:9-15. [PMID: 20234855 PMCID: PMC2836743 DOI: 10.1007/s11657-009-0021-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 05/29/2008] [Indexed: 02/03/2023]
Abstract
SUMMARY: This cross-sectional study showed that peak bone mineral density in Vietnamese women is comparable to that in Caucasian women; however, the prevalence of osteoporosis in post-menopausal Vietnamese women was slightly higher than in Caucasian women. The age of achieving peak bone mass in Vietnamese women was between 26 and 30 years. INTRODUCTION: While peak bone mass and its determinants have been well-documented in Caucasian populations, little has been studied in Asian populations. The present study was designed to estimate the peak bone mineral density (BMD), age of its attainment, and to examine the prevalence of osteoporosis in Vietnamese women aged 50+. METHODS: The study was designed as a cross-sectional study with 328 women aged between 10 and 65 years (average age: 41) who were randomly selected from two districts around Hanoi city according to a stratified sampling scheme. BMD at the lumbar spine, femoral neck and total hip was measured by a DXA instrument (GE Lunar Prodigy, WI, USA). BMD was modeled as a cubic function of age, from which peak BMD and age at peak BMD were estimated. Bootstrap method was utilized to estimate the 95% confidence interval of peak BMD and age at peak BMD. From the peak BMD, T-score was calculated for each woman, and using the World Health Organization criteria, any woman with femoral neck BMD T-score </= -2.5 was classified as having osteoporosis. RESULTS: Peak BMD was estimated at 1.16 g/cm(2) (standard deviation [SD]: 0.13 g/cm(2)) at the lumbar spine, 1.02 g/cm(2) (SD 0.12) at the total hip, and 0.94 g/cm(2) (SD 0.11) at the femoral neck. In the cubic polynomial model, the age at peak BMD was estimated to range between 27 and 29 years. The prevalence of osteoporosis among those aged between 50 and 65 years was 23%. This prevalence was higher than in Chinese, Japanese, Korean and Caucasian populations. CONCLUSION: These data suggest that although the peak BMD in Vietnamese women is comparable to, the prevalence of osteoporosis is higher than, in some other Asian and Caucasian women. It seems that osteoporosis is an important public health burden in Vietnam.
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Affiliation(s)
- H. T. T. Nguyen
- Department of Physiology, Hanoi Medical University, 1 Ton That Tung Street, Dong Da Dist, Hanoi Vietnam ,Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
| | - B. von Schoultz
- Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
| | - D. M. T. Pham
- Department of Physiology, Hanoi Medical University, 1 Ton That Tung Street, Dong Da Dist, Hanoi Vietnam
| | | | - Q. H. Le
- National Cancer Hospital, Hanoi, Vietnam
| | | | - A. L. Hirschberg
- Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
| | - T. V. Nguyen
- Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia
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SÀNCHEZ RIERA L, WILSON NM, SAMBROOK PN, KOK C, CUMMING RG, CAMERON ID, CHEN JS, SIMPSON J, MASON RS, SEIBEL MJ, MARCH LM. Trends in calcium and vitamin D usage among older people in nursing care facilities in Australia: still falling short of the guidelines. Int J Rheum Dis 2008. [DOI: 10.1111/j.1756-185x.2008.00396.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Clover E, Miller M, Bannerman E, Magarey A. Relative validation of a short food frequency questionnaire to assess calcium intake in older adults. Aust N Z J Public Health 2008; 31:450-8. [PMID: 17931293 DOI: 10.1111/j.1753-6405.2007.00117.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop and validate a food frequency questionnaire (FFQ) for estimating calcium intake in community-dwelling older adults using a food record as the reference method. METHOD A validation study involving 102 subjects (67 females) aged > or =65 years and residing independently in Adelaide, Australia, between 2002-06 was performed. Estimates of calcium intake over the last year were calculated from two versions (35 and 15 items) of the FFQ and compared with average intake from four days of non-consecutive food records (4DFR). RESULTS Mean calcium intake from the 4DFR was 987 mg/day (95% CI 922-1051). The 35 and 15-item questionnaires gave mean intakes of 992 mg/day (95% CI 913-1,071) and 1017 mg/day (95% CI 927-1,106) respectively. Mean difference (95% limits of agreement) between the food record and the 35 and 15-item questionnaires was 5 mg (-739-729) and 28 mg (-936-879) respectively. The 15-item questionnaire demonstrated 82% sensitivity for classifying subjects with calcium intake below the estimated average requirement (EAR, 840 mg for males 51-70 years; 1,100 mg for females >51 years and males >70 years of age) and 46% specificity for classifying subjects with intake above the EAR. CONCLUSION The FFQ evaluated as part of this study is one of very few that has been tested across both genders and in older adults specifically. The 15-item version has demonstrated a level of sensitivity and specificity comparable with other FFQs for evaluating calcium intake. IMPLICATIONS The 15-item FFQ can be confidently used for measuring group mean calcium intake in older Australians or as a screening tool to allow health professionals to identify those who are most at risk of inadequate dietary calcium intake.
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Affiliation(s)
- Emma Clover
- Department of Nutrition and Dietetics, Flinders University, South Australia
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Short food frequency questionnaire can discriminate inadequate and adequate calcium intake in Croatian postmenopausal women. Nutr Res 2007. [DOI: 10.1016/j.nutres.2007.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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van der Mei IAF, Ponsonby AL, Engelsen O, Pasco JA, McGrath JJ, Eyles DW, Blizzard L, Dwyer T, Lucas R, Jones G. The high prevalence of vitamin D insufficiency across Australian populations is only partly explained by season and latitude. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:1132-9. [PMID: 17687438 PMCID: PMC1940076 DOI: 10.1289/ehp.9937] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 04/17/2007] [Indexed: 05/16/2023]
Abstract
BACKGROUND Inadequate sun exposure and dietary vitamin D intake can result in vitamin D insufficiency. However, limited data are available on actual vitamin D status and predictors in healthy individuals in different regions and by season. METHODS We compared vitamin D status [25-hydroxyvitamin D; 25(OH)D] in people < 60 years of age using data from cross-sectional studies of three regions across Australia: southeast Queensland (27 degrees S; 167 females and 211 males), Geelong region (38 degrees S; 561 females), and Tasmania (43 degrees S; 432 females and 298 males). RESULTS The prevalence of vitamin D insufficiency (<or= 50 nmol/L) in women in winter/spring was 40.5% in southeast Queensland, 37.4% in the Geelong region, and 67.3% in Tasmania. Season, simulated maximum daily duration of vitamin D synthesis, and vitamin D effective daily dose each explained around 14% of the variation in 25(OH)D. Although latitude explained only 3.9% of the variation, a decrease in average 25(OH)D of 1.0 (95% confidence interval, 0.7-1.3) nmol/L for every degree increase in latitude may be clinically relevant. In some months, we found a high insufficiency or even deficiency when sun exposure protection would be recommended on the basis of the simulated ultraviolet index. CONCLUSION Vitamin D insufficiency is common over a wide latitude range in Australia. Season appears to be more important than latitude, but both accounted for less than one-fifth of the variation in serum 25(OH)D levels, highlighting the importance of behavioral factors. Current sun exposure guidelines do not seem to fully prevent vitamin D insufficiency, and consideration should be given to their modification or to pursuing other means to achieve vitamin D adequacy.
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Sebring NG, Denkinger BI, Menzie CM, Yanoff LB, Parikh SJ, Yanovski JA. Validation of three food frequency questionnaires to assess dietary calcium intake in adults. ACTA ACUST UNITED AC 2007; 107:752-9. [PMID: 17467370 PMCID: PMC2270784 DOI: 10.1016/j.jada.2007.02.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the accuracy of three self-administered food frequency questionnaires (FFQs) to measure dietary calcium intake in healthy adults. DESIGN Estimates of dietary calcium intake from one previously validated and two recently developed FFQs were compared with those from 7-day food records. SUBJECTS/SETTING Healthy adults enrolled in an outpatient study of calcium supplementation completed the 36-page Dietary History Questionnaire (DHQ), a 3-page Calcium Questionnaire, and a 1-page Short Calcium Questionnaire. Subjects then completed a 7-day food record. MAIN OUTCOME MEASURES Differences between calcium intake reported on FFQs and calcium intake from food records were compared. STATISTICAL ANALYSES Spearman correlations were used to measure associations among variables; Bland-Altman pairwise comparisons were conducted to assess systematic and magnitude biases. RESULTS We studied 341 subjects, 74.5% female, mean (+/-standard deviation) age of 38+/-11 years and body mass index (calculated as kg/m(2)) of 31.8+/-7.1. Mean (+/-standard deviation) food record calcium intake was 896+/-380 mg/day; data from all three FFQs were positively related to food record calcium intake, but accounted for <40% of the variance in food record dietary calcium intake (DHQ: r(2)=0.21; Calcium Questionnaire: r(2)=0.33; Short Calcium Questionnaire: r(2)=0.37; all P<0.001). The DHQ underestimated daily calcium intake (systematic bias: -94 mg/day, P<0.001; magnitude bias r=-0.40; P<0.001), whereas the Calcium Questionnaire overestimated calcium intake (systematic bias +177 mg/day, P<0.001), but had no significant magnitude bias (r=-0.09; P=0.11). The Short Calcium Questionnaire showed minimal systematic bias (+34 mg/day, P=0.09), but had magnitude bias (r=-0.33; P<0.001). CONCLUSIONS All three FFQs performed reasonably well at estimating dietary calcium intake compared to food records; each may be appropriate for use in select clinical and research settings.
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Affiliation(s)
- Nancy G Sebring
- Clinical Nutrition Services, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1103, USA
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Zhang Y, Ojima T, Murata C. Calcium intake pattern among Japanese women across five stages of health behavior change. J Epidemiol 2007; 17:45-53. [PMID: 17420612 PMCID: PMC7058461 DOI: 10.2188/jea.17.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 12/08/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The transtheoretical model (TTM) of health behavior change is one of the most promising approaches for health professionals to help individuals change their behaviors. Few studies have assessed calcium intake using the model on Asian women. This study aims at clarifying characteristics of each behavioral stage among Japanese women and providing clues to increase calcium intake to prevent osteoporosis. METHODS A cross-sectional survey was conducted from September through November, 2005 using self-administered questionnaires. A total of 226 participants in an osteoporosis screening program were invited to take part in the study, and 150 women were enrolled. RESULTS Adjusted means of total dietary calcium were positively significantly associated with successive stages (p<0.001). The proportion of calcium intake from plants and fish was higher in the precontemplation, contemplation, and preparation stages compared with the action and maintenance stages (p=0.038). Concomitantly, the plants and fish food group contributed 46.7% of total dietary calcium, while 32.4% was derived from milk and dairy food, and 20.9% from other foods. The correlation coefficient (95% confidence interval) between the proportion of calcium obtained from plants and fish and the proportion of fat energy was -0.22 (-0.37, -0.06). CONCLUSIONS The proportion of calcium intake from plants and fish was higher among women in the lower stages compared with higher stages. Given the higher prevalence of lactose intolerance, it would seem plausible to recommend lower-stage women be educated and encouraged to derive more calcium from plants and fish diets as a means to prevent osteoporosis.
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Affiliation(s)
- Yuan Zhang
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
| | - Chiyoe Murata
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
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Magkos F, Manios Y, Babaroutsi E, Sidossis LS. Differences in the quantitative and qualitative performance of a calcium-specific food frequency questionnaire across age and sex. J Hum Nutr Diet 2007; 19:331-42. [PMID: 16961679 DOI: 10.1111/j.1365-277x.2006.00718.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine putative differences in the quantitative and qualitative performance of a food frequency questionnaire (FFQ) for assessing dietary calcium intake across age and sex in the Greek population. MATERIALS AND METHODS A total of 351 children (189 girls and 162 boys, aged 11.9 +/- 1.2 years), 260 adults (192 women and 68 men, aged 29.6 +/- 2.7 years) and 390 elderly individuals (317 women and 73 men, aged 68.6 +/- 4.6 years) were recruited. Estimates of calcium intake from the 30-item FFQ were compared with those from a multi-pass 24-h recall. RESULTS The FFQ significantly underestimated mean calcium intake in all age groups and both sexes (P < 0.05). The magnitude of underestimation, however, was greater in adults (-207 +/- 344 mg day(-1)), less in the elderly (-137 +/- 310 mg day(-1)) and even less in children (-74 +/- 340 mg day(-1); P < 0.025), with no differences between sexes. Calcium intakes by the two methods were positively and significantly correlated in all study groups (r = 0.536-0.739, P < 0.001). Cohen's weighted kappa statistic ranged from 0.39 to 0.57, indicating moderate agreement between the two methods. The 95% limits of agreement were comparably wide across age and sex (boys: -762, 585 mg day(-1); girls: -747, 624 mg day(-1); adult men: -972, 505 mg day(-1); adult women: -867, 412 mg day(-1); elderly men: -858, 486 mg day(-1); elderly women: -732, 480 mg day(-1)). A significant association between age, sex and the classification of individuals as true/false positive/negative was detected (P < 0.001), implying that sensitivity, specificity, positive and negative predictive values of the FFQ were not independent of the age and sex of the participants. Gross misclassification by the FFQ ranged from 0% to 4.2%, whereas 75.3-87.3% of the subjects were correctly classified. In this respect, the FFQ performed similarly across the study groups (P = 0.065). Without controlling for age, however, gross misclassification appeared to be higher in females than in males (3.2% versus 0.7%, respectively, P = 0.048). CONCLUSIONS There may be several significant differences in the quantitative and qualitative performance of a calcium-specific FFQ across age and sex. This should be taken into account when attempting to evaluate dietary calcium intake in men and women or in different age groups, as some of the differences between study groups may actually be due to the different response of these groups to the FFQ.
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Affiliation(s)
- F Magkos
- Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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Grieger JA, Nowson CA. Nutrient intake and plate waste from an Australian residential care facility. Eur J Clin Nutr 2006; 61:655-63. [PMID: 17151591 DOI: 10.1038/sj.ejcn.1602565] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the plate waste, energy and selected-nutrient intake, from elderly residents living in a high-level care (HLC) and low-level care (LLC) facility. DESIGN Three, single, whole day assessments of plate waste, energy, and selected nutrients, using a visual rating plate waste scale. SETTING Long-term residential care establishment. SUBJECTS One hundred and sixty-nine (93 HLC and 76 LLC) individual daily intakes. MAIN FINDINGS The mean energy wasted throughout the whole day was 17%. The energy wasted from main meals (16%) was significantly less than the energy wasted at mid-meals (22%, P=0.049). The lowest mean energy wastage occurred at breakfast (8%) compared to lunch (22%) and dinner (25%, P<0.001). The mean (s.d.) daily energy served and consumed was 8.1 (2.0) and 6.6 (2.2) MJ, respectively. There was no difference in energy served or consumed between HLC and LLC residents. On the observation day, 60% of residents consumed less than their estimated energy requirement. The mean calcium intake was 796 (346) mg, and the median (inter-quartile range) vitamin D intake was 1.78 (2.05) microg. CONCLUSION On 1 day, more than half the residents surveyed were at risk of consuming an inadequate energy intake, which over-time, may result in body weight loss. Although wastage was not excessive and energy served was adequate, the amount of food eaten was insufficient to meet energy and calcium requirements for a significant number of residents and it is not possible to consume sufficient vitamin D through food sources.
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Affiliation(s)
- J A Grieger
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
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Pasco JA, Henry MJ, Wilkinson LK, Nicholson GC, Schneider HG, Kotowicz MA. Antioxidant vitamin supplements and markers of bone turnover in a community sample of nonsmoking women. J Womens Health (Larchmt) 2006; 15:295-300. [PMID: 16620188 DOI: 10.1089/jwh.2006.15.295] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whereas several epidemiological studies suggest that low dietary intake of vitamins C and E is linked to increased hip fracture in smokers and antioxidants (dietary and endogenous) are reduced in elderly osteoporotic women, none has demonstrated an effect of supplemental antioxidants on bone turnover. METHODS In an observational study of 533 randomly selected women, we investigated the associations among the use of antioxidant supplements, vitamins C and E, serum levels of biochemical markers of bone turnover (C-telopeptide [CTx] and bone-specific alkaline phosphatase [BSAP]), and whole body bone mineral density (BMD). RESULTS Twenty-two women were identified as current users of supplemental vitamin C or E. Duration of antioxidant supplement use was negatively associated with age-adjusted and weight-adjusted serum CTx, such that mean CTx levels (natural log transformed) were 0.022 units lower for each year of exposure. No significant differences were detected for adjusted serum BSAP or whole body BMD. CONCLUSIONS Our results suggest that antioxidant vitamin E or C supplements may suppress bone resorption in nonsmoking postmenopausal women. Coupling of bone formation and resorption may explain the absence of an effect on bone formation markers, given evidence of enhanced effects of antioxidants on osteoblast differentiation; this warrants further investigation. This work adds to the growing body of evidence that antioxidants may play a role in preventing osteoporosis.
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Affiliation(s)
- Julie A Pasco
- The University of Melbourne, Department of Clinical and Biomedical Sciences, Barwon Health, Geelong, Victoria, Australia
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Magkos F, Manios Y, Babaroutsi E, Sidossis LS. Development and validation of a food frequency questionnaire for assessing dietary calcium intake in the general population. Osteoporos Int 2006; 17:304-12. [PMID: 15368091 DOI: 10.1007/s00198-004-1679-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Accepted: 05/17/2004] [Indexed: 02/07/2023]
Abstract
The aim of this study was to develop and evaluate a food frequency questionnaire (FFQ) for assessing dietary calcium intake in the general population, since all available questionnaires at present are age- and/or gender-specific. A total of 1001 individuals (including children, adults, and elderly people of both genders) were randomly recruited throughout Greece. Estimates of calcium intake from the 30-item FFQ were compared with those from a multi-pass 24-h recall. The FFQ underestimated mean calcium intake compared to the 24-h recall by (mean+/-SD) -133+/-333 mg/day or -5.4+/-47.6% (P<0.001). The two methods were strongly correlated (r=0.639, P<0.001), but the 95% limits of agreement for individual assessment were rather wide, as the FFQ could provide estimates of calcium intake from 533 mg/day above to 799 mg/day below the 24-h recall. Actual values for surrogate FFQ quartiles manifested a progressive increase, with significant differences between mean calcium intakes (P<0.001). The FFQ could identify individuals who consumed less calcium than 800 mg/day or less than the age-specific adequate intake with a relatively high sensitivity (82.8 and 95.5%, respectively), but low specificity (54.9 and 34.1%, respectively). Cross-classification analysis indicated that only 17 subjects (1.7%) were grossly misclassified (lowest quartile for one method and highest quartile for the other), while 827 subjects (82.6%) were correctly classified (into the same or adjacent quartiles). The FFQ could be used in population-based epidemiological studies or screening programs involving individuals of all ages and both genders, where the discrimination of subjects with relatively low (<500 mg/day) and relatively high (>1000 mg/day) calcium intakes is of primary interest. Results, however, do not support its use for the quantitative assessment of individual calcium intakes.
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Affiliation(s)
- Faidon Magkos
- Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou Avenue, 17671, Athens, Greece
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Henry MJ, Pasco JA, Pocock NA, Nicholson GC, Kotowicz MA. Reference ranges for bone densitometers adopted Australia-wide: Geelong osteoporosis study. ACTA ACUST UNITED AC 2004; 48:473-5. [PMID: 15601326 DOI: 10.1111/j.1440-1673.2004.01351.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bone densitometry reports a measure of fracture risk in comparison with young adults (T-scores) and age-matched peers (Z-scores). To date, each manufacturer has provided its own reference range resulting in lack of uniformity. The Australia and New Zealand Bone and Mineral Society and Osteoporosis Australia have recognized the need to standardize the reference range and have recommended that data generated by the Geelong Osteoporosis Study (GOS) be used Australia-wide. The GOS recruited a random, population-based sample of adult women and measured bone mineral density (BMD) at the proximal femur and spine using a Lunar DPX-L. These data were used to establish reference ranges for Lunar machines and, using conversion equations, for Norland and Hologic machines. The new standardized Australian reference ranges for BMD will enable consistent diagnosis of osteoporosis and categorization of fracture risk across different types of densitometers.
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Affiliation(s)
- M J Henry
- The University of Melbourne, Department of Clinical and Biomedical Sciences: Barwon Health, Geelong, Victoria, Australia.
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Pasco JA, Henry MJ, Kotowicz MA, Sanders KM, Seeman E, Pasco JR, Schneider HG, Nicholson GC. Seasonal periodicity of serum vitamin D and parathyroid hormone, bone resorption, and fractures: the Geelong Osteoporosis Study. J Bone Miner Res 2004; 19:752-8. [PMID: 15068498 DOI: 10.1359/jbmr.040125] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Revised: 10/27/2003] [Accepted: 01/16/2004] [Indexed: 12/31/2022]
Abstract
UNLABELLED In this population-based study, seasonal periodicity was seen with reduced serum vitamin D, increased serum PTH, and increased bone resorption in winter. This was associated with an increased proportion of falls resulting in fracture and an increased risk of wrist and hip fractures. INTRODUCTION In a population of women who reside in a temperate climate and do not generally receive dietary vitamin D supplementation, we investigated whether seasonal vitamin D insufficiency is associated with increased risk of fracture. MATERIALS AND METHODS An observational, cross-sectional, population-based study set in southeastern Australia (latitude 38-39 degrees S). Participants were drawn from a well-defined community of 27,203 women >/=55 years old: 287 randomly selected from electoral rolls, 1635 with incident fractures, and 1358 presenting to a university hospital with falls. The main outcome measures were annual periodicities of ultraviolet radiation, serum 25-hydroxyvitamin D [25(OH)D], serum parathyroid hormone (PTH), serum C-telopeptide (CTx), BMD, falls, and fractures. RESULTS Cyclic variations in serum 25(OH)D lagged 1 month behind ultraviolet radiation, peaking in summer and dipping in winter (p < 0.001). Periodicity of serum PTH was the inverse of serum 25(OH)D, with a phase shift delay of 1 month (p = 0.004). Peak serum CTx lagged peak serum PTH by 1-2 months. In late winter, a greater proportion of falls resulted in fracture (p < 0.001). Seasonal periodicity in 439 hip and 307 wrist fractures also followed a simple harmonic model (p = 0.078 and 0.002, respectively), peaking 1.5-3 months after the trough in 25(OH)D. CONCLUSIONS A fall in 25(OH)D in winter is accompanied by increases in (1) PTH levels, (2) bone resorption, (3) the proportion of falls resulting in fracture, and (4) the frequency of hip and wrist fracture. Whether vitamin D supplementation in winter can reduce the population burden of fractures requires further investigation.
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Affiliation(s)
- Julie A Pasco
- Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Victoria, Australia
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Pasco JA, Henry MJ, Sanders KM, Kotowicz MA, Seeman E, Nicholson GC. Beta-adrenergic blockers reduce the risk of fracture partly by increasing bone mineral density: Geelong Osteoporosis Study. J Bone Miner Res 2004; 19:19-24. [PMID: 14753732 DOI: 10.1359/jbmr.0301214] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED This population-based study documented beta-blocker use in 59/569 cases with incident fracture and 112/775 controls. OR for fracture associated with beta-blocker use was 0.68 (95%CI, 0.49-0.96). Beta-blockers were associated with higher BMD at the total hip (2.5%) and UD forearm (3.6%) after adjusting for age, anthropometry, and thiazide use. Beta-blocker use is associated with reduced fracture risk and higher BMD. INTRODUCTION Animal data suggests that bone formation is under beta-adrenergic control and that beta-blockers stimulate bone formation and/or inhibit bone resorption. MATERIALS AND METHODS We evaluated the association between beta-blocker use, bone mineral density (BMD), and fracture risk in a population-based study in Geelong, a southeastern Australian city with a single teaching hospital and two radiological centers providing complete fracture ascertainment for the region. Beta-blocker use was documented for 569 women with radiologically confirmed incident fractures and 775 controls without incident fracture. Medication use and lifestyle factors were documented by questionnaire. RESULTS Odds ratio for fracture associated with beta-blocker use was 0.68 (95% CI, 0.49-0.96) for any fracture. Adjusting for age, weight, medications, and lifestyle factors had little effect on the odds ratio. Beta-blocker use was associated with a higher BMD at the total hip (2.5%, p = 0.03) and ultradistal forearm (3.6%, p = 0.04) after adjustment for age, anthropometry, and thiazide use. CONCLUSION Beta-blockers are associated with a reduction in fracture risk and higher BMD.
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Affiliation(s)
- Julie A Pasco
- Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia.
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Henry MJ, Pasco JA, Seeman E, Nicholson GC, Sanders KM, Kotowicz MA. Fracture thresholds revisited. Geelong Osteoporosis Study. J Clin Epidemiol 2002; 55:642-6. [PMID: 12160911 DOI: 10.1016/s0895-4356(02)00396-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Osteoporosis, in the absence of fracture, is defined as a deficit in bone mineral density (BMD) of 2.5 SD or more below the young adult reference mean in postmenopausal Caucasian populations. BMD is a measure of fracture risk but not the sole predictor. We have assessed a combination of easily accessible measures of age, height, weight, and BMD to improve fracture risk assessment. Women with low trauma fractures and a control group were recruited from south-eastern Australia. Discriminant analysis derived multivariate equations that assessed fracture risk. Age was not in the best models at the spine and forearm sites. Weight and height contributed to the relationship for the forearm sites only. At the proximal femur, the BMD level that separates fracture cases from nonfracture cases, increases with age. These separation levels of BMD were higher than the WHO's level of osteoporosis (T-score < -2.5 SD) at ages older than 62 years. This increasing BMD threshold with age suggests that other age-related risk factors assume increasing importance among the elderly.
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Affiliation(s)
- M J Henry
- The University of Melbourne, Department of Clinical and Biomedical Sciences, Barwon Health, P.O. Box 281, Geelong 3220, Australia
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Sambrook PN, Seeman E, Phillips SR, Ebeling PR. Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. Med J Aust 2002; 176:S1-16. [PMID: 12049064 DOI: 10.5694/j.1326-5377.2002.tb04475.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pasco JA, Henry MJ, Nicholson GC, Sanders KM, Kotowicz MA. Vitamin D status of women in the Geelong Osteoporosis Study: association with diet and casual exposure to sunlight. Med J Aust 2001; 175:401-5. [PMID: 11700831 DOI: 10.5694/j.1326-5377.2001.tb143643.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess vitamin D intake and casual exposure to sunshine in relation to serum 25-hydroxyvitamin D (25OHD) levels. DESIGN Cross-sectional study of a population-based, random sample of women aged 20-92 years, assessed between 1994 and 1997. SETTING AND PARTICIPANTS 861 women from the Barwon Statistical Division (population, 218000), which includes the city of Geelong (latitude 38 degrees south) in Victoria. MAIN OUTCOME MEASURES Vitamin D intake; serum 25OHD level; season of assessment; exposure to sunshine. RESULTS Median intake of vitamin D was 1.2 microg/day (range, 0.0-11.4 microg/day). Vitamin D supplements, taken by 7.9% of participants, increased intake by 8.1% to 1.3 microg/day (range, 0.0-101.2 microg/day) (P< 0.001). A dose-response relationship in serum 25OHD levels was observed for sunbathing frequency before and after adjusting for age (P< 0.05). During winter (May-October), serum 25OHD levels were dependent on vitamin D intake (partial r2= 0.01; P<0.05) and were lower than during summer (November-April) (age-adjusted mean, 59nmol/L [95% Cl, 57-62] v 81 nmol/L [95% CI, 78-84]; P<0.05). No association was detected between serum 25OHD and vitamin D intake during summer. The prevalences of low concentrations of serum 25OHD were, for <28nmol/L, 7.2% and 11.3% overall and in winter, respectively; and, for <50 nmol/L, 30.0% and 43.2% overall and in winter, respectively. CONCLUSIONS At latitude 38 degrees south, the contribution of vitamin D from dietary sources appears to be insignificant during summer. However, during winter vitamin D status is influenced by dietary intake. Australia has no recommended dietary intake (RDI) for vitamin D, in the belief that adequate vitamin D can be obtained from solar irradiation alone. Our results suggest that an RDI may be needed.
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Affiliation(s)
- J A Pasco
- The University of Melbourne, Department of Clinical and Biomedical Sciences--Barwon Health, The Geelong Hospital, VIC
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Gulliver P, Horwath C. Women's confidence to consume adequate servings of milk products: validation of a summated rating scale. J Hum Nutr Diet 2001; 14:287-95. [PMID: 11493387 DOI: 10.1046/j.1365-277x.2001.00296.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To design and validate a scale to assess women's confidence to consume adequate servings of milk products. DESIGN Using the electoral rolls as a sampling frame, two large random population surveys of women aged 25-70 years were conducted. The structure of the self-efficacy scale was explored in the first survey of 500 women, and the component structure was refined and confirmed in an independent sample of 1200 women. RESULTS The final single component self-efficacy scale consisted of nine items to assess confidence to consume milk products in various situations. Confidence was higher in women who were already consuming adequate servings of milk products than in women who were not yet ready to consume adequate servings of milk products, providing construct validity for the scale. CONCLUSION The data provide preliminary support for the validity of the self-efficacy scale. The potential usefulness of the scale in interventions designed to improve women's milk product consumption is discussed.
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Affiliation(s)
- P Gulliver
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
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Gulliver P, Horwath C. Women's readiness to follow milk product consumption recommendations: design and evaluation of a 'stage of change' algorithm. J Hum Nutr Diet 2001; 14:277-86. [PMID: 11493386 DOI: 10.1046/j.1365-277x.2001.00295.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate readiness to follow milk product consumption recommendations in two random samples of New Zealand women, using an algorithm designed and evaluated to assess the stage of change construct of the Transtheoretical Model. PROTOCOL Women were classified according to stage of readiness to perform two goal behaviours: consumption of two or four servings of milk products per day. Stage classification, as determined by the algorithm, was evaluated by estimating mean calcium intake in each stage using a validated food frequency questionnaire. This was undertaken in two independent samples of women randomly selected from the electoral rolls of two cities in New Zealand's South Island. RESULTS Over 60% of women were classified as maintaining an intake of two servings of milk products per day. Of those women not meeting the goal of two servings per day, 73% had no intention of increasing their consumption. Over 80% of women were in the precontemplation stage for consuming four servings of milk products per day. Mean calcium intakes were significantly higher in women classified in action and maintenance stages than in preaction stages of change for both goal behaviours. CONCLUSION Of those women not currently meeting the recommendation for two servings of milk products per day, most are in precontemplation, a stage characterized by resistance to change. Use of the staging algorithm developed in this study makes possible the classification of women according to their readiness to change, and thus the provision of appropriate stage-tailored advice.
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Affiliation(s)
- P Gulliver
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
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Henry MJ, Pasco JA, Seeman E, Nicholson GC, Sanders KM, Kotowicz MA. Assessment of fracture risk: value of random population-based samples--the Geelong Osteoporosis Study. J Clin Densitom 2001; 4:283-9. [PMID: 11748333 DOI: 10.1385/jcd:4:4:283] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2001] [Revised: 04/09/2001] [Accepted: 04/30/2001] [Indexed: 11/11/2022]
Abstract
Fracture risk is determined by bone mineral density (BMD). The T-score, a measure of fracture risk, is the position of an individual's BMD in relation to a reference range. The aim of this study was to determine the magnitude of change in the T-score when different sampling techniques were used to produce the reference range. Reference ranges were derived from three samples, drawn from the same region: (1) an age-stratified population-based random sample, (2) unselected volunteers, and (3) a selected healthy subset of the population-based sample with no diseases or drugs known to affect bone. T-scores were calculated using the three reference ranges for a cohort of women who had sustained a fracture and as a group had a low mean BMD (ages 35-72 yr; n = 484). For most comparisons, the T-scores for the fracture cohort were more negative using the population reference range. The difference in T-scores reached 1.0 SD. The proportion of the fracture cohort classified as having osteoporosis at the spine was 26, 14, and 23% when the population, volunteer, and healthy reference ranges were applied, respectively. The use of inappropriate reference ranges results in substantial changes to T-scores and may lead to inappropriate management.
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Affiliation(s)
- M J Henry
- The University of Melbourne, Department of Clinical and Biomedical Sciences, Geelong, Australia
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