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Fitzpatrick D, Laird E, Ward M, Hoey L, Hughes CF, Strain JJ, Cunningham C, Healy M, Molloy AM, McNulty H, Lannon R, McCarroll K. Secondary hyperparathyroidism: Predictors and relationship with vitamin D status, bone turnover markers and bone mineral density. Bone 2024; 184:117108. [PMID: 38642819 DOI: 10.1016/j.bone.2024.117108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) has adverse implications for bone health but is relatively understudied. In this study we examine the prevalence and determinants of SHPT and describe the relationship of SHPT with bone turnover markers and bone mineral density (BMD) in older Irish adults. METHOD Eligible participants (n = 4139) were identified from the Trinity-Ulster-Department of Agriculture (TUDA) study, a cohort of Irish adults aged ≥60 years. Exclusion criteria included an estimated glomerular filtration rate (eGFR) <30 ml/min and serum calcium >2.5 mmol/l to remove hyperparathyroidism due to advanced chronic kidney disease (CKD) and primary hyperparathyroidism respectively. The relationship between SHPT and bone turnover markers and BMD (measured by densitometry) was examined in a subsample (n = 1488). Vitamin D deficiency was defined as 25-hydroxyvitamin D [25 (OH)D] <30 nmol/l. RESULTS Participants had a mean age of 73.6 ± 7.9 years, 65.1 % were female and 19.4 % were found to be vitamin D deficient. The prevalence of SHPT decreased as vitamin D increased, from 30.6 % in those deficient to 9.8 % in those with 25(OH)D ≥ 50 nmol/l and increased with declining kidney function. In non‑calcium supplement users, principal determinants of SHPT were vitamin D deficiency (OR 4.18, CI 3.05-5.73, p < 0.001), eGFR 30-44 ml/min (OR 3.69, CI 2.44-5.57, p < 0.001), loop diuretic use (OR 3.52, CI 2.59-4.79, p < 0.001) and to a lesser extent body mass index (p = 0.001), eGFR 45-59 ml/min (p < 0.001) and 25(OH)D level 30-49 nmol/l (p = 0.002). Similar findings were observed in calcium supplement users, though proton pump inhibitors were also associated with SHPT (OR 1.55, CI 1.08-2.22, p = 0.018) while vitamin D 30-49 nmol/l was not. In participants with SHPT versus those without, bone turnover markers were higher: bone alkaline phosphatase (p = 0.017) and tartrate-resistant acid phosphatase (p = 0.033), whilst there was lower BMD at the neck of femur (0.880 vs. 0.903 g/cm2, p = 0.033) and total hip (0.968 vs. 0.995 g/cm2, P = 0.017). DISCUSSION The results show that up to one in six older Irish adults had SHPT and this was associated with lower BMD and higher concentrations of bone turnover markers. Both vitamin D deficiency and 25(OH)D level 30-49 nmol/l were important predictors of SHPT. Loop diuretics and PPIs may also increase the risk of SHPT, and their use may need to be carefully considered in this population. Further studies examining the potential impact of these factors on bone health in similar populations to our study sample are warranted.
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Affiliation(s)
- Donal Fitzpatrick
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland.
| | - Eamon Laird
- Department of Health & Nutritional Sciences, Atlantic Technological University Sligo, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Conal Cunningham
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, St James's Hospital, Dublin, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Rosaleen Lannon
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland
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Dyer AH, McNulty H, Caffrey A, Gordon S, Laird E, Hoey L, Hughes CF, Ward M, Strain JJ, O'Kane M, Tracey F, Molloy AM, Cunningham C, McCarroll K. Low-Grade systemic inflammation is associated with domain-specific cognitive performance and cognitive decline in older adults: Data from the TUDA study. Neurobiol Aging 2024; 134:94-105. [PMID: 38043161 DOI: 10.1016/j.neurobiolaging.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
Studies examining the relationships between chronic inflammation, cognitive function and cognitive decline in older adults have yielded conflicting results. In a large cohort of older adults free from established dementia (n = 3270; 73.1 ± 7.9 years; 68.4% female), we evaluated the cross-sectional and longitudinal relationships between serum cytokines (IL-6, IL-10, TNF-α) and both global and domain-specific cognitive performance (Repeatable Battery for Assessment of Neuropsychological Status [RBANS]). Higher IL-6 (OR: 1.33; 1.06, 1.66, p = 0.01), TNF-α (OR: 1.35; 1.09, 1.67, p = 0.01) and IL-6:IL-10 Ratio (OR: 1.43; 1.17, 1.74, p = 0.001) were cross-sectionally associated with impaired global RBANS performance. For specific cognitive domains, greatest effect sizes were observed between higher TNF-α levels and poorer visual-spatial and attention performance. In a subset of participants (n = 725; 69.8 ± 5.5 years; 67.0% female) with repeat assessment performed at a median of 5.4 years, only higher baseline IL-6:IL-10 ratio was associated with impaired incident overall, immediate memory and visual-spatial performance. Associations were stronger in females, but not modified by age or APOE genotype.
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Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, United Kingdom; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, United Kingdom.
| | - Helene McNulty
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Aoife Caffrey
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Shane Gordon
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Eamon Laird
- Department of Physical Education and Sport Science, University of Limerick, United Kingdom
| | - Leane Hoey
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Catherine F Hughes
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Mary Ward
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, Northern Ireland, United Kingdom
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, Northern Ireland, United Kingdom
| | | | - Conal Cunningham
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, United Kingdom; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Kevin McCarroll
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, United Kingdom; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Fitzpatrick D, Lannon R, Laird E, Ward M, Hoey L, Hughes CF, Strain JJ, Cunningham C, McNulty H, Molloy AM, McCarroll K. The association between proton pump inhibitors and hyperparathyroidism: a potential mechanism for increased fracture-results of a large observational cohort study. Osteoporos Int 2023; 34:1917-1926. [PMID: 37530847 PMCID: PMC10579148 DOI: 10.1007/s00198-023-06867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture; however, the mechanism is unclear. PPI users taking calcium supplements were more likely to have hyperparathyroidism compared to non-users (OR 1.56, CI 1.08-2.23, p = 0.018). This highlights the importance of monitoring PPI use, especially in older adults. PURPOSE Proton pump inhibitors (PPIs) are associated with increased risk of osteoporotic fracture. Hyperparathyroidism may be implicated, but few studies have considered this relationship. This study evaluated the relationship between PPI use and hyperparathyroidism in older adults. METHODS Participants were from the TUDA study, a large cross-sectional cohort of older Irish adults. Participants with an estimated glomerular filtration rate (eGFR) < 30 ml/min and serum calcium > 2.5 mmol/l were excluded to avoid hyperparathyroidism due to chronic renal disease and primary hyperparathyroidism. Hyperparathyroidism was defined as a parathyroid hormone (PTH) > 65 pg/ml. Multivariate regression models were used to analyse the relationship between PPI use and hyperparathyroidism. RESULTS A total of 4139 participants met the inclusion criteria, of whom 37.8% (n = 1563) were taking PPI medication. PPI use was identified in 41.4% of calcium supplement users and 35.4% of non-calcium supplement users. Overall, compared to non-users of PPIs, those taking PPIs were older (74.8 vs 72.9 years, p < 0.001) and had a higher prevalence of hyperparathyroidism (17.8 vs 11.0%, p < 0.001). In those taking calcium supplements (but not in non-users), PPI use was significantly associated with hyperparathyroidism (OR 1.56, CI 1.08-2.23, p = 0.018) after adjusting for age, sex, body mass index, serum vitamin D, eGFR, timed-up-and-go, dairy intake, medications, and comorbidities. DISCUSSION The results are consistent with the hypothesis of PPIs reducing calcium absorption, leading to a rise in PTH which could mediate increased fracture risk. No relationship of PPI use with hyperparathyroidism was observed in non-users of calcium supplements, possibly owing to lower dietary calcium intake. These results highlight the importance of monitoring PPI use, especially in older adults at risk of fracture.
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Affiliation(s)
- Donal Fitzpatrick
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland.
| | - Rosaleen Lannon
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - Eamon Laird
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Conal Cunningham
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, Northern Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College, Dublin, Ireland
| | - Kevin McCarroll
- The Mercers Institute for Research On Ageing, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
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Angelino D, Caffrey A, McNulty H, Gill CI, Mena P, Rosi A, Moore K, Hoey L, Clements M, Laird E, Boyd K, Mullen B, Pucci B, Jarrett H, Cunningham C, Ward M, Strain JJ, McCarroll K, Moore AJ, Molloy AM, Del Rio D. Association of dietary flavan-3-ol intakes with plasma phenyl-γ-valerolactones: analysis from the TUDA cohort of healthy older adults. Am J Clin Nutr 2023; 118:476-484. [PMID: 37307990 PMCID: PMC10493433 DOI: 10.1016/j.ajcnut.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Dietary polyphenols, including flavan-3-ols (F3O), are associated with better health outcomes. The relationship of plasma phenyl-γ-valerolactones (PVLs), the products of colonic bacterial metabolism of F3O, with dietary intakes is unclear. OBJECTIVES To investigate whether plasma PVLs are associated with self-reported intakes of total F3O and procyanidins+(epi)catechins. DESIGN We measured 9 PVLs by uHPLC-MS-MS in plasma from adults (>60y) in the Trinity-Ulster-Department of Agriculture (TUDA study (2008 to 2012; n=5186) and a follow-up subset (2014 to 2018) with corresponding dietary data (n=557). Dietary (poly)phenols collected by FFQ were analyzed using Phenol-Explorer. RESULTS Mean (95% confidence interval [CI]) intakes were estimated as 2283 (2213, 2352) mg/d for total (poly)phenols, 674 (648, 701) for total F3O, and 152 (146, 158) for procyanidins+(epi)catechins. Two PVL metabolites were detected in plasma from the majority of participants, 5-(hydroxyphenyl)-γ-VL-sulfate (PVL1) and 5-(4'-hydroxyphenyl)-γ-VL-3'-glucuronide (PVL2). The 7 other PVLs were detectable only in 1-32% of samples. Self-reported intakes (mg/d) of F3O (r = 0.113, P = 0.017) and procyanidin+(epi)catechin (r = 0.122, P = 0.010) showed statistically significant correlations with the sum of PVL1 and PVL 2 (PVL1+2). With increasing intake quartiles (Q1-Q4), mean (95% CI) PVL1+2 increased; from 28.3 (20.8, 35.9) nmol/L in Q1 to 45.2 (37.2, 53.2) nmol/L in Q4; P = 0.025, for dietary F3O, and from 27.4 (19.1, 35.8) nmol/L in Q1 to 46.5 (38.2, 54.9) nmol/L in Q4; P = 0.020, for procyanidins+(epi)catechins. CONCLUSIONS Of 9 PVL metabolites investigated, 2 were detected in most samples and were weakly associated with intakes of total F3O and procyanidins+(epi)catechins. Future controlled feeding studies are required to validate plasma PVLs as biomarkers of these dietary polyphenols.
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Affiliation(s)
- Donato Angelino
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy; Department of Bioscience and Technology for Food, Agriculture, and Environment, University of Teramo, Teramo, Italy
| | - Aoife Caffrey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Chris Ir Gill
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Pedro Mena
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy; Microbiome Research Hub, University of Parma, Parma, Italy
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - Katie Moore
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Michelle Clements
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Eamon Laird
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland
| | - Kerrie Boyd
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland
| | - Brian Mullen
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland
| | - Bruna Pucci
- School of Geography and Environmental Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Harry Jarrett
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Conal Cunningham
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Kevin McCarroll
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland
| | - Adrian J Moore
- School of Geography and Environmental Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Anne M Molloy
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland
| | - Daniele Del Rio
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy; Microbiome Research Hub, University of Parma, Parma, Italy.
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Clements M, Heffernan M, Ward M, Hoey L, Doherty LC, Hack Mendes R, Clarke MM, Hughes CF, Love I, Murphy S, McDermott E, Grehan J, McCann A, McAnena LB, Strain JJ, Brennan L, McNulty H. A 2-Year Randomized Controlled Trial With Low-Dose B-Vitamin Supplementation Shows Benefits on Bone Mineral Density in Adults With Lower B12 Status. J Bone Miner Res 2022; 37:2443-2455. [PMID: 36128889 PMCID: PMC10092614 DOI: 10.1002/jbmr.4709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/04/2022] [Accepted: 09/17/2022] [Indexed: 01/19/2023]
Abstract
Folate, vitamins B12, B6, and riboflavin are required for one-carbon metabolism and may affect bone health, but no previous randomized trial has investigated all four nutrients in this context. We investigated the effect of low-dose B-vitamins for 2 years on bone mineral density (BMD) in a dual-centered, 2-year randomized controlled trial (RCT) in adults aged ≥50 years. Eligible participants not consuming B-vitamin supplements or fortified foods >4 times weekly were randomized to receive daily either combined folic acid (200 μg), vitamin B12 (10 μg), vitamin B6 (10 mg), and riboflavin (5 mg), or "active" placebo, whereby both the intervention and placebo groups received vitamin D (10 μg). BMD was assessed before and after intervention using dual-energy X-ray absorptiometry (DXA) scanning of the total hip, femoral neck, and lumbar spine (L1 to L4). Of 205 eligible participants randomized, 167 completed the trial in full. B-vitamin intervention resulted in increases in serum folate (p < 0.001), serum B12 (p < 0.001), and plasma pyridoxal-5-phosphate (p < 0.001) and decreases in functional biomarkers of B-vitamin status, erythrocyte glutathione reductase activation coefficient (p < 0.001), serum methylmalonic acid (MMA; p < 0.001), and serum total homocysteine (p < 0.001). B-vitamin intervention had no overall effect on BMD, which declined in both treatment groups by approximately 1% (ranging from -0.7% to -1.4%). However, in participants with lower baseline B12 status (serum B12 <246 pmol/L or MMA ≥0.22 μmol/L), B-vitamin intervention reduced the 2-year BMD decline versus placebo: adjusted mean (95% confidence interval [CI]) change of -0.003 (-0.008, 0.002) versus -0.015 (-0.021, -0.010) g/cm2 at the total hip and -0.004 (-0.010, 0.001) versus -0.013 (-0.018, -0.007) g/cm2 at the femoral neck. In conclusion, the findings indicate that although low-dose B-vitamin intervention for 2 years had no overall effect on BMD, improving B-vitamin status appears to have specific benefits for bone health in adults with lower B12 status. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Michelle Clements
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Maria Heffernan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Leanne C Doherty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Roberta Hack Mendes
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Michelle M Clarke
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Ingrid Love
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Shauna Murphy
- Section of Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Eilish McDermott
- Section of Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jennifer Grehan
- Section of Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Liadhan B McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Lorraine Brennan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
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Carlin P, Wallace J, Moore A, Hughes C, Black M, Rankin D, Hoey L, McNulty H. Dementia Analytics Research User Group (DARUG) ‐ A Model for meaningful stakeholder engagement in dementia research. Alzheimers Dement 2022; 18 Suppl 2:e062288. [DOI: 10.1002/alz.062288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | - Leane Hoey
- Ulster University Belfast United Kingdom
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Fitzpatrick D, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Cunningham C, McCarroll K. 72 SEASONAL VARIATION IN HYPERPARATHYROIDISM IN OLDER IRISH ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Vitamin D deficiency is common in Ireland, varies by season and can result in secondary hyperparathyroidism. High Parathyroid Hormone (PTH) levels due to low vitamin D status are associated with increased bone turnover and lower bone mineral density, especially at cortical sites such as the hip. Given the variation in vitamin D status by time of year, our study aimed to examine for seasonal differences in hyperparthyroidism in older adults.
Methods
Study participants were from a large cross-sectional study of older Irish adults recruited from hospital outpatient services and GP practices. Exclusion criteria were: eGFR< 30ml/min and elevated serum calcium (>2.5 mmol/l) in order to avoid primary hyperparathyroidism or elevated serum PTH due to advanced renal impairment. Hyperparathyroidism was defined as a PTH level > 65 ng/ml. The relationship between hyperparathyroidism and season was examined in regression models adjusting for potential factors affecting PTH.
Results
There were 4324 participants, mean age 73.8 +/- 7.9 years, 65.4% were female. Hyperparathyroidism was more prevalent in Spring versus Autumn (17.4 vs 11.4 %, P = 0.0002). The increased prevalence remained after adjusting for age, gender, body mass index, timed up and go, dairy intake, eGFR, and smoking (OR 1.6, 1.2- 2.0, P=0.0003). This also corresponded to the seasonal variation in vitamin D status with deficiency (25(OH)D < 30 nmol/l) highest in Spring (23.3%) and lowest in Autumn (16.8%).
Conclusion
We found that hyperparathyroidism fluctuates with season in an inverse relationship with vitamin D. Overall, high PTH levels were 60% more likely in Spring versus Autumn. This emphasises the importance of maintaining adequate vitamin D status all year round. While we adjusted for dairy intake, we did not have accurate measures of total dietary calcium intake which could also vary seasonally and be a contributory factor.
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Affiliation(s)
- D Fitzpatrick
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - F Tracey
- Causeway Hospital, Northern Health and Social Care Trust , Coleraine, Northern Ireland, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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Kavanagh M, Bradley E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Laird E, Cunningham C, McCarroll K. 51 VITAMIN D DEFICIENCY IS ASSOCIATED WITH INCREASED RISK OF ATRIAL FIBRILLATION: A CROSS-SECTIONAL ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is prevalent (up to 10.9%) in Irish adults aged over 65 and significantly increases stroke risk, as well as being associated with greater stroke severity. Identifying potential contributing factors to development of AF offers opportunity for AF prevention and reduction in associated morbidity. Low vitamin D status has been associated with AF but studies are inconsistent. We aimed to assess the potential relationship between vitamin D deficiency and self-reported AF in older Irish adults.
Methods
Participants were from a large cross-sectional study of Irish adults aged >60 years, recruited from hospital outpatient services and GP practises. The diagnosis of AF was based on self-report so those with a Mini Mental State Examination (MMSE) <25 were excluded. Vitamin D deficiency was defined as a 25(OH)D <30 nmol/l. The relationship between deficiency and AF was explored in regression models.
Results
4264 participants, mean age 73.1± 8.0 years, female (67.4%) and 11.9% had AF. There was a higher prevalence of AF in those who were deficient vs non-deficient (17.2% vs 10.9%, P<0.0001). In a subsample (n = 4043), increased risk remained after adjusting for age, gender, season, vitamin D supplement use, body mass index, timed up and go, alcohol intake, smoking status, hypertension, diabetes, and heart disease (coronary artery disease and/or heart failure) (OR: 1.3, 1.1- 1.7 , P =0.023).
Conclusion
We identified that vitamin D deficiency was independently associated with a 30% increased likelihood of self-reported AF in older adults. Vitamin D is known to inhibit the renin angiotensin, aldosterone system which may play a role in both structural and electrical remodelling of the atrium. It may also have anti-inflammatory properties which could protect against AF. We were not able to distinguish between valvular and non-valvular AF though findings offer an interesting insight for potential further investigation.
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Affiliation(s)
- M Kavanagh
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - E Bradley
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - F Tracey
- Causeway Hospital, Northern Health and Social Care Trust , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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9
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Fitzpatrick D, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Cunningham C, Carroll KM. 73 PREVALENCE OF SECONDARY HYPERPARATHYROIDISM BY VITAMIN D STATUS IN OLDER IRISH ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Secondary hyperparathyroidism commonly results from vitamin D deficiency and can lead to accelerated bone turnover and bone loss, especially at cortical sites like the hip. It can also attenuate the response to antiresorptive treatments used for osteoporosis. However, several factors may influence PTH response. We aimed to identify the prevalence of secondary hyperparathyroidism by categories of vitamin D status in older Irish adults attending a bone health clinic.
Methods
The study population consisted of older adults (aged over 60 years) attending a bone health clinic at a large hospital. Participants with a serum calcium >2.5 mmol/l and eGFR <30 ml/min were excluded to avoid cases of primary hyperparathyroidism or elevated serum PTH due to advanced renal disease. Hyperparathyroidism was defined as a serum PTH > 65 pg/ml. 25 hydroxyvitamin D (25(OH)D) was measured with liquid chromatography mass spectroscopy.
Results
There were 800 cases identified, mean age 72.9 +/- 7.9 years, and 85.3% were female. The prevalence of secondary hyperparathyroidism by 25(OH)D categories were 28.1% (<30nmol/l), 17.4% (30-49.9 nmol/l) and 8.0% (50-74 nmol/l). Older age (P < 0.03) and lower eGFR (P = 0.01) were associated with hyperparathyroidism independent of vitamin D status.
Conclusion
Nearly one-third of patients who were vitamin D deficient (<30 nmol/L) and one-sixth who were insufficient (30-49.9 nmol/l) had hyperparathyroidism, similar to the results of other studies. However, hyperparathyroidism was also observed in 8% of those with 25(OH)D levels between 50 -74 nmol/l, suggesting that higher levels i.e. ≥ 75 nmol/l may be preferable in older adults. Lower eGFR and older age were also independently associated with higher PTH, consistent with previous research. Higher dietary and supplemental calcium intake is also known to suppress PTH response, though we were not able to account for this in our study.
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Affiliation(s)
- D Fitzpatrick
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, Northern Ireland, United Kingdom
| | - F Tracey
- Causeway Hospital, Northern Health and Social Care Trust , Coleraine, Northern Ireland, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - KM Carroll
- Mercer's Institute for Successful Ageing, St. James's Hospital , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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10
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Dyer A, Dolphin H, Laird E, Hoey L, McNulty H, Hughes C, Ward M, Strain JJ, O'Kane M, Tracey F, Molloy A, Cunningham C, McCarroll K. 17 CROSS-SECTIONAL AND LONGITUDINAL RELATIONSHIPS BETWEEN MOBILITY, NEUROPSYCHOLOGICAL PERFORMANCE AND FALLS IN COMMUNITY-DWELLING OLDER ADULTS: DATA FROM TUDA. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Impaired mobility is associated with incident cognitive impairment and dementia. However, the complex bi-directional temporal relationships between subtle impairments in neuropsychological performance, mobility trajectories and falls is poorly understood.
Methods
Using data from the Trinity, Ulster Department of Agriculture (TUDA/TUDA5+) study, we evaluated cross-sectional and longitudinal relationships between impaired mobility, neuropsychological performance and falls using regression models adjusted for important clinical confounders. Older adults with potential cognitive impairment (Mini-Mental State Examination score <25) were excluded. Detailed neuropsychological assessment was performed using the RBANS (Repeatable Battery for Neuropsychological Assessment) and FAB (Frontal Assessment Battery). Impaired mobility was assessed using Irish population-specific age/sex/height-specific Timed-Up-and-Go (TUG) cut-offs.
Results
Of 4,103 participants (72.9 ± 7.9 years; 67.4% female), just under one-fifth (17.5%) met criteria for impaired mobility. Older adults with impaired mobility had significantly greater likelihood of impaired neuropsychological performance, in particular for language (OR 1.77; 1.35-2.31; p<0.001) and attention (OR 1.69; 1.37-2.08; p<0.001) domains. In 953 participants followed for a median 5.2 (IQR: 4.83-7.26) years, impaired mobility at baseline significantly predicted incident impairment in immediate memory (OR 2.56; 1.33-4.95; p<0.001). Stronger relationships were seen for impaired neuropsychological performance predicting mobility decline rather than impaired mobility predicting cognitive decline (all p<0.001). Both impaired mobility and neuropsychological performance were associated with incident falls, particularly for impairments in executive function and attention (all p<0.001). Impaired mobility in isolation had poor performance as a sole test to predict incident cognitive impairment (AUC: 0.55-0.65).
Conclusion
In both cross-sectional and longitudinal analyses, impaired mobility is associated with subtle impairments in neuropsychological performance. Whilst impaired neuropsychological performance was a greater predictor of impaired mobility rather than vice versa, our findings highlight the complex relationship between mobility and cognitive trajectories in older adults, emphasising the need for comprehensive cognitive and falls assessment in those presenting with new-onset subtle impairments in mobility and cognition.
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Affiliation(s)
- A Dyer
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - H Dolphin
- Tallaght University Hospital Age-Related Healthcare, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M O'Kane
- Altnagelvin Hospital, Western Health and Social Care Trust Clinical Chemistry, , Londonderry, United Kingdom
| | - F Tracey
- Northern Health and Social Care Trust Causeway Hospital, , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Aging , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
| | - K McCarroll
- Mercer's Institute for Successful Aging , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, , Dublin, Ireland
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11
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Breslin L, Bradley E, Fitzpatrick D, Laird E, Hoey L, Hughes C, McNulty H, Strain JJ, Ward M, Tracey F, Molloy A, Cunningham C, McCarroll K. 261 HIGH FRACTURE RISK IN OLDER IRISH ADULT FALLERS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fracture risk due to falls depends on several factors including bone density, quality and size, hip geometry (axis length), direction of fall (forward, backwards or sideways), body mass index (BMI), type of surface impacted, body site of impact and mechanism of fall (eg syncope). We aimed to identify the fracture risk per fall in frail older Irish adults.
Methods
Participants were from the hypertensive and cognitive cohort of the Trinity, Ulster, Dept Agriculture (TUDA) study of Irish adults (aged >60) recruited from hospital outpatient services and GP practises. Falls and falls resulting in fracture in the previous year were self-reported so those with an MMSE < 25 were excluded to avoid recall bias. We identified fallers, recurrent fallers and fractures due to falls in the previous year.
Results
892 fallers, mean age 76.3 ± 8.4 yrs, 65.2% female. 23.8% had 2 falls and 24.2% ≥3 falls. Mean timed up and go was 17.3 ± 9.5 seconds. Commonest fracture due to falls were hip (20.1%), upper limb (18.5%) and lower limb (17.9%) with one fracture of neck and skull. Fracture rate per fall was 7.1%: 1.7% for hip, 1.3% for lower and 1.2% for upper limb. Annual fracture rate per faller was 16.5%. The only predictors of fall with fracture versus no fracture were female sex (OR 2.4, 1.6-3.6, P<0.001) and lower body mass index (P=0.001).
Conclusion
We identified similar hip fracture rates (1.7%) due to falls as in other studies. However, one in six fallers had sustained a fracture in the previous year reflecting the high proportion of recurrent fallers. Lower BMI and female sex predicted fall with fracture as both are strongly correlated with risk of osteoporosis. Recent guidelines now factor in recurrent falls when estimating the probability of future osteoporotic fractures.
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Affiliation(s)
- L Breslin
- Mercer's Institute for Successful Ageing, St. James Hospital , Dublin, Ireland
| | - E Bradley
- Mercer's Institute for Successful Ageing, St. James Hospital , Dublin, Ireland
| | - D Fitzpatrick
- Mercer's Institute for Successful Ageing, St. James Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, , Coleraine, United Kingdom
| | - F Tracey
- Northern Health and Social Care Trust Causeway Hospital, , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - C Cunningham
- Trinity College Dublin Mercer's Institute for Successful Ageing, St. James's Hospital, Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- Trinity College Dublin Mercer's Institute for Successful Ageing, St. James's Hospital, Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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12
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Feely O, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Tracey F, Molloy A, Cunningham C, Fallon N, Lannon R, McCarroll K. 126 CENTRAL ADIPOSITY IS ASSOCIATED WITH INCREASED PREVALENCE OF VERTEBRAL FRACTURES. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Increased body weight and obesity are associated with greater bone mineral density (BMD) though effects on fracture risk appear to be site specific. In particular, the relationship between Body Mass Index (BMI), abdominal weight and Vertebral Fractures (VF) is complex. Some studies have found greater incidence of VF's with obesity though results are inconsistent. Recent evidence supports a stronger association between measures of abdominal fat and VF's. We aimed to examine the association between central adiposity and VF's in older Irish adults.
Methods
Participants were from a large cross-sectional study of older Irish adults (aged >60) attending GP or hospital outpatient services. VF diagnosis was based on self-report (ie. clinical vertebral fracture) so we excluded those with a Mini Mental State Examination (MMSE) < 25. BMD was measured with DXA and patients taking antiresorptive or anabolic therapies were excluded. The relationship of waist hip ratio (a surrogate marker of central adiposity) with VF's was explored in regression models.
Results
2055 identified, mean age 69.8 ± 6.3 years (range 60-99), 58.6% female. Vertebral fracture prevalence was 6.3% (n=130). Waist hip ratio was positively associated with presence of a vertebral fracture after adjusting for age, sex, BMI, timed up and go, smoking, serum vitamin D, lumbar spine BMD and steroid use > 3 months (beta: 0.04, P<0.001).
Conclusion
We identified that central adiposity (as measured by waist/hip ratio) was associated with VF presence independent of several factors including BMI and spine BMD. This suggests that body fat distribution and/or altered bone quality may play a role. Visceral body fat (which is correlated with waist hip ratio) is associated with increased production of adipocytokines, altered vertebral geometry and micro-architecture, increased vertebral bone marrow fat and greater loading forces on the spine, all of which may mediate increased VF risk.
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Affiliation(s)
- O Feely
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
| | - E Laird
- Trinity College Dublin Department of Clinical Medicine, , Dublin, Ireland
| | - L Hoey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - C Hughes
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - JJ Strain
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - F Tracey
- Ulster University The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A Molloy
- Northern Health and Social Care Trust Causeway Hospital, , Coleraine, United Kingdom
| | - C Cunningham
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - N Fallon
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
| | - R Lannon
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - K McCarroll
- St. James's Hospital Mercer's Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Department of Medical Gerontology, School of Medicine, , Dublin, Ireland
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13
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Dyer AH, Laird E, Hoey L, Hughes CF, McNulty H, Ward M, Strain JJ, O’Kane M, Tracey F, Molloy AM, Cunningham C, Sexton DJ, McCarroll K. Reduced kidney function is associated with poorer domain-specific cognitive performance in community-dwelling older adults. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5771. [PMID: 35719039 PMCID: PMC9327725 DOI: 10.1002/gps.5771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Whilst chronic kidney disease has been associated with cognitive impairment, the association between reduced estimated Glomerular Filtration Rate (eGFR) and domain-specific cognitive performance is less clear and may represent an important target for the promotion of optimal brain health in older adults. METHODS Participants aged >60 years from the Trinity-Ulster-Department of Agriculture study underwent detailed cognitive assessment using the Mini-Mental State Examination (Mini-Mental State Examination (MMSE)), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Poisson and linear regression models assessed the relationship between eGFR strata and cognitive performance. RESULTS In 4887 older adults (73.9 ± 8.3 years; 67.7% female), declining eGFR strata was associated with greater likelihood of error on the MMSE/FAB and poorer overall performance on the RBANS. Following robust covariate adjustment, findings were greatest for GFR <45 ml/ml/1.73 m2 (Incidence Rate Ratio: 1.17; 95% CI 1.08, 1.27; p < 0.001 for MMSE; IRR: 1.13; 95% CI 1.04, 1.13; p < 0.001 for FAB; β: -3.66; 95% CI -5.64, -1.86; p < 0.001 for RBANS). Additionally, eGFR <45 ml/ml/1.73 m2 was associated with poorer performance on all five RBANS domains, with greatest effect sizes for immediate memory, delayed memory and attention. Associations were strongest in those aged 60-70, with no associations observed in those >80 years. CONCLUSIONS Reduced kidney function was associated with poorer global and domain-specific neuropsychological performance. Associations were strongest with eGFR <45 ml/min/1.73 m2 and in those aged 60-70 years, suggesting that this population may potentially benefit from potential multi-domain interventions aimed at promoting optimal brain health in older adults.
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Affiliation(s)
- Adam H. Dyer
- Mercer's Institute for Successful AgeingSt James's HospitalDublinIreland,Wellcome‐HRB Clinical Research FacilitySt James's HospitalDublinIreland,Department of Medical GerontologySchool of MedicineTrinity College DublinDublinIreland
| | - Eamon Laird
- Department of Medical GerontologySchool of MedicineTrinity College DublinDublinIreland
| | - Leane Hoey
- The Nutrition Innovation Centre for Food and Health (NICHE)School of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
| | - Catherine F. Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE)School of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
| | - Helene McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE)School of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
| | - Mary Ward
- The Nutrition Innovation Centre for Food and Health (NICHE)School of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
| | - J. J. Strain
- The Nutrition Innovation Centre for Food and Health (NICHE)School of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
| | - Maurice O’Kane
- Clinical Chemistry LaboratoryAltnagelvin HospitalWestern Health and Social Care TrustLondonderryNorthern IrelandUK
| | - Fergal Tracey
- Causeway HospitalNorthern Health and Social Care TrustColeraineNorthern IrelandUK
| | | | - Conal Cunningham
- Mercer's Institute for Successful AgeingSt James's HospitalDublinIreland,Wellcome‐HRB Clinical Research FacilitySt James's HospitalDublinIreland
| | - Donal J. Sexton
- Department of Medical GerontologySchool of MedicineTrinity College DublinDublinIreland,School of MedicineTrinity College DublinDublinIreland,Trinity Health Kidney CentreSchool of MedicineTrinity College DublinDublinIreland
| | - Kevin McCarroll
- Mercer's Institute for Successful AgeingSt James's HospitalDublinIreland,Department of Medical GerontologySchool of MedicineTrinity College DublinDublinIreland
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14
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Dyer A, Laird E, Hoey L, Hughes C, McNulty H, Ward M, Strain JJ, Molloy A, Cunnningham C, Sexton D, McCarroll K. 43 REDUCED KIDNEY FUNCTION IS ASSOCIATED WITH POORER GLOBAL AND DOMAIN-SPECIFIC COGNITIVE PERFORMANCE IN COMMUNITY-DWELLING OLDER ADULTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Chronic Kidney Disease (CKD) is an important risk factor in the development of cognitive impairment. However, the association between reduced estimated Glomerular Filtration Rate (eGFR) and performance on domain-specific cognitive and neuropsychological assessments is less clear and may represent an important target in the promotion of optimal brain health in older adults.
Methods
Participants from the Trinity, Ulster and Department of Agriculture cohort study underwent detailed assessment of cognitive and neuropsychological function using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Mixed-effects Poisson and linear regression was used to assess the relationship between eGFR strata and cognitive/neuropsychological test performance.
Results
4,887 participants were included (73.94 ± 8.25 years; 67.7% female). Reduced eGFR was associated with poorer performance on all three cognitive assessments, most pronounced in those with eGFR <45 mL/mL/1.73m2 (IRR: 1.19; 95% CI: 1.09, 1.29; p < 0.001 for MMSE/IRR: 1.14; 95% CI 1.04, 1.24; p < 0.001 for the FAB/β: -3.23; 95% CI -5.18, −1.30; p = 0.001 for RBANS, fully adjusted). Reduced eGFR was associated with poorer performance on immediate memory, visual–spatial and attention RBANS domains. Associations were strongest in the youngest old (<70 years) with no association observed in those aged >80 years.
Conclusion
Reduced kidney function was associated with poorer global and domain-specific function in community-dwelling older adults. Associations were strongest for those with eGFR <45 mL/min/1.73m2 and the youngest-old, suggesting that this group may be most at risk and may benefit from potential preventative interventions.
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Affiliation(s)
- A Dyer
- St James's Hospital , Dublin, Ireland
| | - E Laird
- Trinity College Dublin , Dublin, Ireland
| | - L Hoey
- Ulster University , Coleraine, United Kingdom
| | - C Hughes
- Ulster University , Coleraine, United Kingdom
| | - H McNulty
- Ulster University , Coleraine, United Kingdom
| | - M Ward
- Ulster University , Coleraine, United Kingdom
| | - J J Strain
- Ulster University , Coleraine, United Kingdom
| | - A Molloy
- Trinity College Dublin , Dublin, Ireland
| | | | - D Sexton
- Trinity Health Kidney Centre , Dublin, Ireland
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15
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Dyer AH, Briggs R, Laird E, Hoey L, Hughes CF, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. Glycated haemoglobin (HbA 1c ), diabetes and neuropsychological performance in community-dwelling older adults. Diabet Med 2021; 38:e14668. [PMID: 34343367 DOI: 10.1111/dme.14668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/17/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Abstract
AIMS Given that diabetes is associated with cognitive impairment and dementia in later life, we aimed to investigate the relationship between glycated haemoglobin (HbA1c ), diabetes and domain-specific neuropsychological performance in older adults. METHODS Cross-sectional cohort study using data from the Trinity-Ulster-Department of Agriculture (TUDA) study. Participants underwent detailed cognitive and neuropsychological assessment using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Assessment for Neuropsychological Status (RBANS). Linear regression was used to assess associations between HbA1c , diabetes status and neuropsychological performance, with adjustment for important clinical covariates. RESULTS Of 4938 older adults (74.1 ± 8.3 years; 66.9% female), 16.3% (n = 803) had diabetes (HbA1c ≥ 6.5%; 48 mmol/mol), with prediabetes (HbA1c ≥ 5.7%-6.4%; 39-47 mmol/mol) present in 28.3% (n = 1395). Increasing HbA1c concentration was associated with poorer overall performance on the FAB [β: -0.01 (-0.02, -0.00); p = 0.04 per % increase] and RBANS [β = -0.66 (-1.19, -0.13); p = 0.02 per % increase]. Increasing HbA1c was also associated with poorer performance on immediate memory, visuo-spatial, language and attention RBANS domains. Diabetes was associated poorer performance on neuropsychological tests of immediate memory, language, visual-spatial and attention. CONCLUSIONS Both increasing HbA1c and the presence of diabetes were associated with poorer cognitive and domain-specific performance in older adults. HbA1c , and not just diabetes status per se, may represent an important target in the promotion of optimal brain health in older adults.
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Affiliation(s)
- Adam H Dyer
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
- Wellcome-HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
| | - Robert Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Eamon Laird
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Leane Hoey
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Catherine F Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Helene McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Mary Ward
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conal Cunningham
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
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Dyer AH, Laird E, Hoey L, Hughes CF, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. Long-term anticholinergic, benzodiazepine and Z-drug use in community-dwelling older adults: What is the impact on cognitive and neuropsychological performance? Int J Geriatr Psychiatry 2021; 36:1767-1777. [PMID: 34227695 DOI: 10.1002/gps.5598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Long-term use of anticholinergics, benzodiazepines and related drugs (or "Z-drugs") have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain-specific neuropsychological performance in older adults without dementia, is unclear. METHODS 5135 older adults (74.0 ± 8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity-Ulster-Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). RESULTS A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% (n = 500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% (n = 363), whilst 7.5% (n = 387) used a "Z-drug". Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: -0.09; 95% CI: -0.14, -0.03, p = 0.002 for MMSE; β: -0.04; 95% CI: -0.06, -0.02; p < 0.001 for FAB; β: -4.15; 95% CI: -5.64, -2.66; p < 0.001 for RBANS) in addition to all domains of the RBANS. Regular benzodiazepine use was also associated with poorer neuropsychological test performance, especially in Immediate Memory (β: -4.98; 95% CI: -6.81, -3.15; p < 0.001) and Attention (β: -6.81; 95% CI: -8.60, -5.03; p < 0.001) RBANS domains. CONCLUSIONS Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or "Z-drugs", was associated with poorer overall and domain-specific neuropsychological performance in older adults.
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Affiliation(s)
- Adam H Dyer
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Eamon Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Leane Hoey
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, NI, UK
| | - Catherine F Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, NI, UK
| | - Helene McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, NI, UK
| | - Mary Ward
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, NI, UK
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, NI, UK
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conal Cunningham
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Kevin McCarroll
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Porter KM, Hoey L, Hughes CF, Ward M, Clements M, Strain J, Cunningham C, Casey MC, Tracey F, O'Kane M, Pentieva K, McAnena L, McCarroll K, Laird E, Molloy AM, McNulty H. Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B-12 status, and the impact of fortified foods, in older adults. Am J Clin Nutr 2021; 114:1286-1294. [PMID: 34134144 PMCID: PMC8488868 DOI: 10.1093/ajcn/nqab193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking. OBJECTIVES To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults. METHODS Eligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008-2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value < -0.5. A pepsinogen I:II ratio <3 was considered indicative of AG. RESULTS AG was identified in 15% of participants and associated with significantly lower serum total vitamin B-12 (P < 0.001) and plasma holotranscobalamin (holoTC; P < 0.001), and higher prevalence of vitamin B-12 deficiency (38%), compared with PPI users (21%) and controls (without AG and nonusers of PPIs; 15%; P < 0.001). PPI drugs were used (≥6 mo) by 37% of participants and were associated with lower holoTC concentrations, but only in participants taking higher doses (≥30 mg/d). Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0-4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG. CONCLUSIONS Older adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced vitamin B-12 status, but higher levels of added vitamin B-12 than currently provided could be warranted to optimize status in people with AG.
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Affiliation(s)
- Kirsty M Porter
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Michelle Clements
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Jj Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Conal Cunningham
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Miriam C Casey
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, Northern Ireland, United Kingdom
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom
| | - Kristina Pentieva
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Eamon Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom
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Jungert A, McNulty H, Hoey L, Ward M, Strain JJ, Hughes CF, McAnena L, Neuhäuser-Berthold M, Pentieva K. Riboflavin Is an Important Determinant of Vitamin B-6 Status in Healthy Adults. J Nutr 2020; 150:2699-2706. [PMID: 32805038 DOI: 10.1093/jn/nxaa225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Riboflavin is required to generate the active form of vitamin B-6 (pyridoxal 5'-phosphate; PLP) in tissues, but the relevance of this metabolic interaction for nutritional status of vitamin B-6 is unclear because riboflavin biomarkers are rarely measured in human studies. OBJECTIVES The purpose of this study was to identify the determinants of biomarkers of vitamin B-6 and riboflavin status and to examine the relationship between these nutrients in healthy adults. METHODS Multiple linear regression was performed on observational data in 407 healthy adults aged 18-92 y who did not use B-vitamin supplements. Vitamin B-6 status was assessed by plasma PLP concentrations and erythrocyte glutathione reductase activation coefficient (EGRac) was used as a functional indicator of riboflavin status. RESULTS Dietary intakes of vitamin B-6 and riboflavin were below the average requirements in 10% and 29% of participants, respectively. Suboptimal status of vitamin B-6 (PLP ≤30.0 nmol/L) was more prevalent in adults aged ≥60 y than in younger participants (i.e., 14% compared with 5%), whereas a high proportion (i.e., overall 37%) of both age groups had deficient riboflavin status (EGRac ≥1.40). In multiple regression analysis, EGRac (P = 0.019) was a significant determinant of plasma PLP, along with dietary vitamin B-6 intake (P = 0.003), age (P < 0.001), BMI (kg/m2) (P = 0.031), and methylenetetrahydrofolate reductase gene (MTHFR) genotype (P < 0.001). Significant determinants of EGRac were dietary riboflavin intake (P < 0.001), age (P < 0.001) and MTHFR genotype (P = 0.020). Plasma PLP showed a stepwise decrease across riboflavin status categories from optimal (EGRac ≤1.26) to low (EGRac 1.27-1.39) to deficient status (P = 0.001), independent of dietary vitamin B-6 intake. CONCLUSIONS The findings are consistent with the known metabolic dependency of vitamin B-6 on riboflavin status and indicate that riboflavin may be the limiting nutrient, particularly in older people, for maintaining adequate vitamin B-6 status.
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Affiliation(s)
- Alexandra Jungert
- Interdisciplinary Research Center for Biosystems, Land Use and Nutrition (IFZ), Biometry and Population Genetics, Justus Liebig University, Giessen, Germany
| | - Helene McNulty
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
| | - Leane Hoey
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
| | - J J Strain
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
| | - Catherine F Hughes
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
| | - Liadhan McAnena
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
| | | | - Kristina Pentieva
- Nutrition Innovation Centre for food and Health (NICHE), Ulster University, Coleraine, United Kingdom
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Rankin D, Black M, Flanagan B, Hughes CF, Moore A, Hoey L, Wallace J, Gill C, Carlin P, Molloy AM, Cunningham C, McNulty H. Identifying Key Predictors of Cognitive Dysfunction in Older People Using Supervised Machine Learning Techniques: Observational Study. JMIR Med Inform 2020; 8:e20995. [PMID: 32936084 PMCID: PMC7527918 DOI: 10.2196/20995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Machine learning techniques, specifically classification algorithms, may be effective to help understand key health, nutritional, and environmental factors associated with cognitive function in aging populations. OBJECTIVE This study aims to use classification techniques to identify the key patient predictors that are considered most important in the classification of poorer cognitive performance, which is an early risk factor for dementia. METHODS Data were used from the Trinity-Ulster and Department of Agriculture study, which included detailed information on sociodemographic, clinical, biochemical, nutritional, and lifestyle factors in 5186 older adults recruited from the Republic of Ireland and Northern Ireland, a proportion of whom (987/5186, 19.03%) were followed up 5-7 years later for reassessment. Cognitive function at both time points was assessed using a battery of tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with a score <70 classed as poorer cognitive performance. This study trained 3 classifiers-decision trees, Naïve Bayes, and random forests-to classify the RBANS score and to identify key health, nutritional, and environmental predictors of cognitive performance and cognitive decline over the follow-up period. It assessed their performance, taking note of the variables that were deemed important for the optimized classifiers for their computational diagnostics. RESULTS In the classification of a low RBANS score (<70), our models performed well (F1 score range 0.73-0.93), all highlighting the individual's score from the Timed Up and Go (TUG) test, the age at which the participant stopped education, and whether or not the participant's family reported memory concerns to be of key importance. The classification models performed well in classifying a greater rate of decline in the RBANS score (F1 score range 0.66-0.85), also indicating the TUG score to be of key importance, followed by blood indicators: plasma homocysteine, vitamin B6 biomarker (plasma pyridoxal-5-phosphate), and glycated hemoglobin. CONCLUSIONS The results suggest that it may be possible for a health care professional to make an initial evaluation, with a high level of confidence, of the potential for cognitive dysfunction using only a few short, noninvasive questions, thus providing a quick, efficient, and noninvasive way to help them decide whether or not a patient requires a full cognitive evaluation. This approach has the potential benefits of making time and cost savings for health service providers and avoiding stress created through unnecessary cognitive assessments in low-risk patients.
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Affiliation(s)
- Debbie Rankin
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry~Londonderry, United Kingdom
| | - Michaela Black
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry~Londonderry, United Kingdom
| | - Bronac Flanagan
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry~Londonderry, United Kingdom
| | - Catherine F Hughes
- School of Biomedical Sciences, Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Adrian Moore
- School of Geography and Environmental Sciences, Ulster University, Coleraine, United Kingdom
| | - Leane Hoey
- School of Biomedical Sciences, Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Jonathan Wallace
- School of Computing, Ulster University, Jordanstown, United Kingdom
| | - Chris Gill
- School of Biomedical Sciences, Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Paul Carlin
- School of Health, Wellbeing and Social Care, The Open University, Belfast, United Kingdom
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conal Cunningham
- Mercers Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Helene McNulty
- School of Biomedical Sciences, Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
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Constantin E, MacLean J, Barrowman N, Hoey L, Horwood L, Bendiak G, Kirk V, Hadjiyannakis S, Legault L, Foster B, Katz S. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Porter KM, Ward M, Hughes CF, O'Kane M, Hoey L, McCann A, Molloy AM, Cunningham C, Casey MC, Tracey F, Strain S, McCarroll K, Laird E, Gallagher AM, McNulty H. Hyperglycemia and Metformin Use Are Associated With B Vitamin Deficiency and Cognitive Dysfunction in Older Adults. J Clin Endocrinol Metab 2019; 104:4837-4847. [PMID: 30920623 DOI: 10.1210/jc.2018-01791] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 03/22/2019] [Indexed: 02/02/2023]
Abstract
CONTEXT Emerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes. OBJECTIVE To determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults. SETTING AND PARTICIPANTS Community-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment. MAIN OUTCOME MEASURES Biomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB). RESULTS Metformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤-1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74). CONCLUSIONS Use of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.
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Affiliation(s)
- Kirsty M Porter
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Western Health and Social Care Trust, Altnagelvin Hospital, Londonderry, Northern Ireland, United Kingdom
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | | | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conal Cunningham
- Mercers Institute for Research on Aging, St James's Hospital, Dublin, Ireland
| | - Miriam C Casey
- Mercers Institute for Research on Aging, St James's Hospital, Dublin, Ireland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, Northern Ireland, United Kingdom
| | - Sean Strain
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Kevin McCarroll
- Mercers Institute for Research on Aging, St James's Hospital, Dublin, Ireland
| | - Eamon Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alison M Gallagher
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
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Moore K, Hughes CF, Hoey L, Ward M, Cunningham C, Molloy AM, Strain J, McCarroll K, Casey MC, Tracey F, Laird E, O'Kane M, McNulty H. B-vitamins in Relation to Depression in Older Adults Over 60 Years of Age: The Trinity Ulster Department of Agriculture (TUDA) Cohort Study. J Am Med Dir Assoc 2019; 20:551-557.e1. [DOI: 10.1016/j.jamda.2018.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 12/13/2022]
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Hughes CF, Porter K, Moore K, Ward M, Cunningham C, McCarroll K, Tracey F, Molloy AM, Hoey L, Strain JJ, Casey MC, Laird E, O’Kane MJ, Pentieva K, McNulty H. 269B-Vitamin Biomarker Status - Predictors of Cognitive Function and Decline in Older Adults Over A 5-year Follow-up: The TUDA Study. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Kirsty Porter
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Katie Moore
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Conal Cunningham
- Mercer’s Institute for Research on Ageing, St James’s Hospital, Dublin, Ireland
| | - Kevin McCarroll
- Mercer’s Institute for Research on Ageing, St James’s Hospital, Dublin, Ireland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, United Kingdom
| | - Anne M Molloy
- Institute of Molecular Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Miriam C Casey
- Mercer’s Institute for Research on Ageing, St James’s Hospital, Dublin, Ireland
| | - Eamon Laird
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, United Kingdom
| | - Maurice J O’Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, United Kingdom
| | - Kristina Pentieva
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
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Tracey CA, Clarke MM, Hughes CF, Bruls V, Rigby J, McNulty H, Casey MC, Cunningham C, Tracey F, McCarroll K, Hoey L, Ward M, Strain JJ, Molloy AM, Moore A. 260The Impact of Area Based Socioeconomic Deprivation on Osteoporosis. Age Ageing 2018. [DOI: 10.1093/ageing/afy141.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Clare A Tracey
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Michelle M Clarke
- School of Agriculture & Food Science, University College Dublin, Dublin, Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Vivian Bruls
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Jan Rigby
- National Centre for GeoComputation, Maynooth University, Maynooth, Ireland, Maynooth, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Miriam C Casey
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland
| | - Conal Cunningham
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care Trust, Coleraine, United Kingdom
| | - Kevin McCarroll
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - J J Strain
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Anne M Molloy
- Institute of Molecular Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Adrian Moore
- School of Environmental Sciences, Ulster University, Coleraine, United Kingdom
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Novaković R, Geelen A, Ristić-Medić D, Nikolić M, Souverein OW, McNulty H, Duffy M, Hoey L, Dullemeijer C, Renkema JMS, Gurinović M, Glibetić M, de Groot LCPGM, Van't Veer P. Systematic Review of Observational Studies with Dose-Response Meta-Analysis between Folate Intake and Status Biomarkers in Adults and the Elderly. Ann Nutr Metab 2018; 73:30-43. [PMID: 29879709 DOI: 10.1159/000490003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/14/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dietary reference values for folate intake vary widely across Europe. METHODS MEDLINE and Embase through November 2016 were searched for data on the association between folate intake and biomarkers (serum/plasma folate, red blood cell [RBC] folate, plasma homocysteine) from observational studies in healthy adults and elderly. The regression coefficient of biomarkers on intake (β) was extracted from each study, and the overall and stratified pooled β and SE (β) were obtained by random effects meta-analysis on a double log scale. These dose-response estimates may be used to derive folate intake reference values. RESULTS For every doubling in folate intake, the changes in serum/plasma folate, RBC folate and plasma homocysteine were +22, +21, and -16% respectively. The overall pooled regression coefficients were β = 0.29 (95% CI 0.21-0.37) for serum/plasma folate (26 estimates from 17 studies), β = 0.28 (95% CI 0.21-0.36) for RBC (13 estimates from 11 studies), and β = -0.21 (95% CI -0.31 to -0.11) for plasma homocysteine (10 estimates from 6 studies). CONCLUSION These estimates along with those from randomized controlled trials can be used for underpinning dietary recommendations for folate in adults and elderly.
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Affiliation(s)
- Romana Novaković
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Danijela Ristić-Medić
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Marina Nikolić
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Olga W Souverein
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Helene McNulty
- School of Biomedical Sciences, University of Ulster, Coleraine Campus, Londonderry, United Kingdom
| | - Maresa Duffy
- School of Biomedical Sciences, University of Ulster, Coleraine Campus, Londonderry, United Kingdom
| | - Leane Hoey
- School of Biomedical Sciences, University of Ulster, Coleraine Campus, Londonderry, United Kingdom
| | - Carla Dullemeijer
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Jacoba M S Renkema
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Mirjana Gurinović
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Marija Glibetić
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Pieter Van't Veer
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
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McCann A, McNulty H, Rigby J, Hughes CF, Hoey L, Molloy AM, Cunningham CJ, Casey MC, Tracey F, O’Kane MJ, McCarroll K, Ward M, Moore K, Strain J, Moore A. Effect of Area‐Level Socioeconomic Deprivation on Risk of Cognitive Dysfunction in Older Adults. J Am Geriatr Soc 2018; 66:1269-1275. [DOI: 10.1111/jgs.15258] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Adrian McCann
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Jan Rigby
- National Centre for GeoComputationMaynooth UniversityMaynoothIreland
| | - Catherine F. Hughes
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Leane Hoey
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Anne M. Molloy
- Institute of Molecular Medicine, School of Medicine, Trinity College DublinDublinIreland
| | | | - Miriam C. Casey
- Mercer's Institute for Research on Ageing, St James's HospitalDublinIreland
| | - Fergal Tracey
- Causeway Hospital, Northern Health and Social Care TrustColeraineNorthern IrelandUnited Kingdom
| | - Maurice J. O’Kane
- Clinical Chemistry LaboratoryAltnagelvin Hospital, Western Health and Social Care TrustLondonderryNorthern IrelandUnited Kingdom
| | - Kevin McCarroll
- Mercer's Institute for Research on Ageing, St James's HospitalDublinIreland
| | - Mary Ward
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Katie Moore
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - J.J. Strain
- Nutrition Innovation Centre for Food and HealthUlster UniversityColeraineNorthern IrelandUnited Kingdom
| | - Adrian Moore
- School of Environmental SciencesUlster UniversityColeraineNorthern IrelandUnited Kingdom
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Love D, Mabaya G, Katz S, Lawson M, Price A, Radhakrishnan D, Mah J, Korngut L, McMillan H, Scholtes C, Shephard A, Hoey L, Heletea M, Campbell C. Understanding decision needs for respiratory interventions in paediatric neuromuscular disorders. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Laird E, Molloy AM, McNulty H, Ward M, McCarroll K, Hoey L, Hughes CF, Cunningham C, Strain JJ, Casey MC. Greater yogurt consumption is associated with increased bone mineral density and physical function in older adults. Osteoporos Int 2017; 28:2409-2419. [PMID: 28462469 DOI: 10.1007/s00198-017-4049-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/10/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED In this cohort of community dwelling older adults (>60 years), we observed significant positive associations between the frequencies of yogurt intake with measures of bone density, bone biomarkers, and indicators of physical function. Improving yogurt intakes could be a valuable health strategy for maintaining bone health in older adults. INTRODUCTION The associations of yogurt intakes with bone health and frailty in older adults are not well documented. The aim was to investigate the association of yogurt intakes with bone mineral density (BMD), bone biomarkers, and physical function in 4310 Irish adults from the Trinity, Ulster, Department of Agriculture aging cohort study (TUDA). METHODS Bone measures included total hip, femoral neck, and vertebral BMD with bone biochemical markers. Physical function measures included Timed Up and Go (TUG), Instrumental Activities of Daily Living Scale, and Physical Self-Maintenance Scale. RESULTS Total hip and femoral neck BMD in females were 3.1-3.9% higher among those with the highest yogurt intakes (n = 970) compared to the lowest (n = 1109; P < 0.05) as were the TUG scores (-6.7%; P = 0.013). In males, tartrate-resistant acid phosphatase (TRAP 5b) concentrations were significantly lower in those with the highest yogurt intakes (-9.5%; P < 0.0001). In females, yogurt intake was a significant positive predictor of BMD at all regions. Each unit increase in yogurt intake in females was associated with a 31% lower risk of osteopenia (OR 0.69; 95% CI 0.49-0.96; P = 0.032) and a 39% lower risk of osteoporosis (OR 0.61; 95% CI 0.42-0.89; P = 0.012) and in males, a 52% lower risk of osteoporosis (OR 0.48; 95% CI 0.24-0.96; P = 0.038). CONCLUSION In this cohort, higher yogurt intake was associated with increased BMD and physical function scores. These results suggest that improving yogurt intakes could be a valuable public health strategy for maintaining bone health in older adults.
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Affiliation(s)
- E Laird
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - A M Molloy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H McNulty
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - M Ward
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - K McCarroll
- St James's Hospital, The Mercers Institute for Research on Ageing, Dublin, Ireland
| | - L Hoey
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - C F Hughes
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - C Cunningham
- St James's Hospital, The Mercers Institute for Research on Ageing, Dublin, Ireland
| | - J J Strain
- Northern Ireland Centre for Food and Health, Ulster University , Coleraine, UK
| | - M C Casey
- St James's Hospital, The Mercers Institute for Research on Ageing, Dublin, Ireland
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O'Sullivan F, Laird E, Kelly D, van Geffen J, van Weele M, McNulty H, Hoey L, Healy M, McCarroll K, Cunningham C, Casey M, Ward M, Strain JJ, Molloy AM, Zgaga L. Ambient UVB Dose and Sun Enjoyment Are Important Predictors of Vitamin D Status in an Older Population. J Nutr 2017; 147:858-868. [PMID: 28331054 DOI: 10.3945/jn.116.244079] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/01/2016] [Accepted: 02/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background: UVB-induced skin synthesis is considered the key source of vitamin D, yet exposure to UVB is poorly accounted for in epidemiological studies.Objectives: The aim of this study was to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentration with accurately measured ambient UVB dose, sun enjoyment, supplements, and other factors.Methods: An all-Irish cohort of community-dwelling participants aged >60 y [median age: 73; 67% female; median 25(OH)D: 54.5 nmol/L] was used. Participants from this large, cross-sectional study completed a questionnaire to provide information on demographic factors and lifestyle (including supplement use and sun enjoyment). The Tropospheric Emission Monitoring Internet Service database was used to extract the daily ambient UVB dose at wavelengths that could induce vitamin D synthesis (D-UVB) over Ireland (latitude: 51°N-55°N). Blood sampling occurred throughout the year. Ambient exposure at the place of residence was calculated for each participant individually. Associations between determinants and serum 25(OH)D concentration were examined in a multivariate model. Random forest analysis was used to establish prediction models of vitamin D deficiency, and area under the curve (AUC) is shown.Results: In total, 5138 individuals were included. Median D-UVB was 63 mJ/cm2, which varied between seasons and latitudes, despite the small latitude differential. Vitamin D supplementation (β = 27.7; P < 10 × 10-10), D-UVB (β = 1.58 per 1000 mJ/cm2; P < 10 × 10-10), and sun enjoyment (β = 6.6; P < 0.001) were strongly positively associated with serum 25(OH)D. Those who avoided sunshine were largely at risk of deficiency (<40 nmol/L), whereas those who enjoyed sunshine tended to be vitamin D sufficient (≥50 nmol/L). D-UVB and sun enjoyment improved prediction of deficiency in non-supplement-taking individuals; the overall AUC improved by 3.5%.Conclusion: D-UVB and sun enjoyment are important predictors of vitamin D status, even in this elderly population at northern latitudes. Accurate estimation of ambient UVB can help to further clarify the role of other determinants of vitamin D status and inform sunshine recommendation guidelines.
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Affiliation(s)
| | - Eamon Laird
- School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Dervla Kelly
- Department of Public Health and Primary Care and
| | - Jos van Geffen
- Royal Netherlands Meteorological Institute, De Bilt, Netherlands
| | | | - Helene McNulty
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom; and
| | - Leane Hoey
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom; and
| | | | - Kevin McCarroll
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Conal Cunningham
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Miriam Casey
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Mary Ward
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom; and
| | - J J Strain
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, United Kingdom; and
| | - Anne M Molloy
- School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Lina Zgaga
- Department of Public Health and Primary Care and
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Affiliation(s)
- K. Moore
- Northern Ireland Centre for Food and Health; Ulster University Coleraine; Coleraine UK
| | - M. O'Shea
- Northern Ireland Centre for Food and Health; Ulster University Coleraine; Coleraine UK
| | - C. F. Hughes
- Northern Ireland Centre for Food and Health; Ulster University Coleraine; Coleraine UK
| | - L. Hoey
- Northern Ireland Centre for Food and Health; Ulster University Coleraine; Coleraine UK
| | - M. Ward
- Northern Ireland Centre for Food and Health; Ulster University Coleraine; Coleraine UK
| | - H. McNulty
- Northern Ireland Centre for Food and Health; Ulster University Coleraine; Coleraine UK
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Laird E, Casey MC, Ward M, Hoey L, Hughes CF, McCarroll K, Cunningham C, Strain JJ, McNulty H, Molloy AM. Dairy Intakes in Older Irish Adults and Effects on Vitamin Micronutrient Status: Data from the TUDA Study. J Nutr Health Aging 2017; 21:954-961. [PMID: 29083435 DOI: 10.1007/s12603-016-0845-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Consumption of dairy products has been associated with positive health outcomes including a lower risk of hypertension, improved bone health and a reduction in the risk of type 2 diabetes. The suggested dairy intake for health in older adults is three servings per day but recent analysis of the NHANES data for older adults reported 98% were not meeting these recommendations. No studies have investigated the consequences of such declines in the dairy intakes of Irish older adults and the subsequent effects on vitamin micronutrient status. OBJECTIVES To study the daily dairy intakes of older Irish adults and to examine how the frequency of dairy food consumption affects vitamin micronutrient status. METHODS Participants (n 4,317) were from the Trinity Ulster Department of Agriculture (TUDA) Study, a large study of older Irish adults (aged >60 yrs) designed to investigate gene-nutrient interactions in the development of chronic diseases of aging. The daily intake portion for milk, cheese and yoghurt was calculated from food frequency questionnaire (FFQ) responses. Blood samples were analysed for vitamin biomarkers as follows: vitamin B12 (total serum cobalamin and holotranscobalamin (holoTC)), folate (red cell folate (RCF) and serum folate), vitamin B2 (erythrocyte glutathione reductase activation coefficient (EGRac)), vitamin B6 (serum pyridoxal phosphate) and vitamin D (serum 25(OH)D). RESULTS The mean total reported dairy intake was 1.16 (SD 0.79) portions per day with males consuming significantly fewer total dairy portions compared to females (1.07 vs 1.21 respectively) (P<0.05). There was no significant difference in total daily dairy serving intakes by age decade (60-69, 70-79, >80 yrs). Overall, only 3.5% of the total population (n 151) achieved the recommended daily dairy intake of three or more servings per day. A significantly higher proportion of females (4%) compared to males (2.4%) met these dairy requirements (P=0.011). Blood concentrations of vitamin B12 biomarkers, RCF, vitamin B2 and vitamin B6 were significantly worse in those with the lowest tertile of dairy intake (0-0.71 servings) compared to those in the highest tertile (1.50-4.50 servings) (P<0.05). CONCLUSION This study found that more than 96% of the older adults sampled did not meet current daily dairy intake recommendations. The study is the largest to-date examining dairy intakes in older Irish adults, and provides evidence that daily dairy intakes (in particular yogurt) contribute significantly to the B-vitamin and vitamin D biomarker status of older adults. These results suggest that older adults who are already vulnerable to micronutrient inadequacies, are forgoing the nutritional advantages of vitamin-rich dairy products.
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Affiliation(s)
- E Laird
- E. Laird, School of Biochemistry and Immunology, Trinity College Dublin, Ireland,
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Altic L, McNulty H, Hoey L, McAnena L, Pentieva K. Validation of Folate-Enriched Eggs as a Functional Food for Improving Folate Intake in Consumers. Nutrients 2016; 8:nu8120777. [PMID: 27916895 PMCID: PMC5188432 DOI: 10.3390/nu8120777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/15/2016] [Accepted: 11/26/2016] [Indexed: 11/16/2022] Open
Abstract
Functional foods enriched with folate may be beneficial as a means of optimizing folate status in consumers. We recently developed novel eggs enriched with folate through folic acid supplementation of the hen’s feed, but their potential to influence consumer folate status is unknown because the natural folate forms incorporated into the eggs may not necessarily be retained during storage and cooking. This study aimed to determine the stability of natural folates in folate-enriched eggs under typical conditions of storage and cooking. Total folate was determined by microbiological assay following tri-enzyme treatment in folate-enriched eggs and un-enriched (barn and free-range) on the day they were laid, after storage (up to 27 days) and after using four typical cooking methods (boiling, poaching, frying, scrambling) for different durations. On the day of laying, the folate content of enriched eggs was found to be significantly higher than that of un-enriched barn or free-range eggs (mean ± SD; 123.2 ± 12.4 vs. 41.2 ± 2.8 vs. 65.6 ± 18.5 µg/100 g; p < 0.001). Storage at refrigerator and room temperature for periods up to the Best Before date resulted in no significant losses to the folate content of folate-enriched eggs. Furthermore, folate in enriched eggs remained stable when cooked by four typical methods for periods up to the maximum cooking time (e.g., 135 ± 22.5, 133.9 ± 23.0 and 132.5 ± 35.1; p = 0.73, for raw, scrambled for 50 s and scrambled for 2 min, respectively). Thus, natural folates in folate-enriched eggs remain highly stable with little or no losses following storage and cooking. These findings are important because they demonstrate the feasibility of introducing folate-enriched eggs into the diet of consumers as functional foods with enriched folate content. Further studies will confirm their effectiveness in optimizing the biomarker folate status of consumers.
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Affiliation(s)
- Leslie Altic
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Helene McNulty
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Leane Hoey
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Liadhan McAnena
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
| | - Kristina Pentieva
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine BT52 1SA, UK.
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Porter K, Hoey L, Hughes CF, Ward M, McNulty H. Causes, Consequences and Public Health Implications of Low B-Vitamin Status in Ageing. Nutrients 2016; 8:E725. [PMID: 27854316 PMCID: PMC5133110 DOI: 10.3390/nu8110725] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 12/11/2022] Open
Abstract
The potential protective roles of folate and the metabolically related B-vitamins (vitamins B12, B6 and riboflavin) in diseases of ageing are of increasing research interest. The most common cause of folate and riboflavin deficiencies in older people is low dietary intake, whereas low B12 status is primarily associated with food-bound malabsorption, while sub-optimal vitamin B6 status is attributed to increased requirements in ageing. Observational evidence links low status of folate and the related B-vitamins (and/or elevated concentrations of homocysteine) with a higher risk of degenerative diseases including cardiovascular disease (CVD), cognitive dysfunction and osteoporosis. Deficient or low status of these B-vitamins alone or in combination with genetic polymorphisms, including the common MTHFR 677 C → T polymorphism, could contribute to greater disease risk in ageing by causing perturbations in one carbon metabolism. Moreover, interventions with the relevant B-vitamins to optimise status may have beneficial effects in preventing degenerative diseases. The precise mechanisms are unknown but many have been proposed involving the role of folate and the related B-vitamins as co-factors for one-carbon transfer reactions, which are fundamental for DNA and RNA biosynthesis and the maintenance of methylation reactions. This review will examine the evidence linking folate and related B-vitamins with health and disease in ageing, associated mechanisms and public health implications.
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Affiliation(s)
- Kirsty Porter
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Leane Hoey
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Catherine F Hughes
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Mary Ward
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
| | - Helene McNulty
- Northern Ireland Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK.
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Coen RF, McCarroll K, Casey M, McNulty H, Laird E, Molloy AM, Ward M, Strain JJ, Hoey L, Hughes C, Cunningham CJ. The Frontal Assessment Battery: Normative Performance in a Large Sample of Older Community-Dwelling Hospital Outpatient or General Practitioner Attenders. J Geriatr Psychiatry Neurol 2016; 29:338-343. [PMID: 27647791 DOI: 10.1177/0891988716666381] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Frontal Assessment Battery (FAB) is a short battery designed to assess frontal executive functioning, but data for interpretation of performance are limited. OBJECTIVES The Trinity, Ulster, Department of Agriculture (TUDA) study provided the opportunity to derive performance data from a large sample of community-dwelling hospital outpatient or general practitioner (GP) attenders. METHODS Normative analysis based on 2508 TUDA participants meeting these criteria: Mini-Mental State Examination (MMSE) >26/30, not depressed (Center for Epidemiologic Studies Depression <16) or anxious (Hospital Anxiety and Depression Scale <8), no history of stroke, or transient ischemic attack. Correlation and regression analyses were used to evaluate the effects of age, education, gender, and general cognition (MMSE). Norms for FAB were created stratified by age and education, using overlapping midpoint ranges of 10 years with a 3-year interval from age 60 to 97. RESULTS Age and education accounted for 9.6% of variance in FAB score ( r2 = .096) with no significant effect of gender. The FAB and MMSE were modestly correlated ( r = .29, P < .01) with MMSE increasing the model's total explained variance in FAB score from 9.6% to 14%. CONCLUSION This is the largest study to date to create normative data for the FAB. Age and education had the most significant impact on FAB performance, which was largely independent of global cognition (MMSE). These data may be of benefit in interpreting FAB performance in individuals with similar demographic/health status characteristics in hospital outpatient or GP settings.
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Affiliation(s)
- Robert F Coen
- 1 Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Kevin McCarroll
- 1 Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Miriam Casey
- 1 Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Helene McNulty
- 2 Northern Ireland Centre for Food and Health Centre, Ulster University, Coleraine, Northern Ireland
| | - Eamon Laird
- 3 Institute of Molecular Medicine, Trinity College, Dublin, Ireland
| | - Anne M Molloy
- 3 Institute of Molecular Medicine, Trinity College, Dublin, Ireland
| | - M Ward
- 2 Northern Ireland Centre for Food and Health Centre, Ulster University, Coleraine, Northern Ireland
| | - J J Strain
- 2 Northern Ireland Centre for Food and Health Centre, Ulster University, Coleraine, Northern Ireland
| | - Leane Hoey
- 2 Northern Ireland Centre for Food and Health Centre, Ulster University, Coleraine, Northern Ireland
| | - Catherine Hughes
- 2 Northern Ireland Centre for Food and Health Centre, Ulster University, Coleraine, Northern Ireland
| | - Conal J Cunningham
- 1 Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
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McCarroll K, Beirne A, Casey M, McNulty H, Ward M, Hoey L, Molloy A, Laird E, Healy M, Strain JJ, Cunningham C. Determinants of 25-hydroxyvitamin D in older Irish adults. Age Ageing 2015; 44:847-53. [PMID: 26265675 DOI: 10.1093/ageing/afv090] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/04/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND vitamin D deficiency is prevalent in older adults living in Northern Europe and is influenced by several factors which may vary significantly with age. OBJECTIVE we aimed to investigate the determinants of 25-hydroxyvitamin D [25(OH)D] in older Irish adults and in particular to examine the effect of supplement use and surrogate markers of sun exposure. METHODS subjects were non-institutionalised community dwelling Irish adults aged over 60 years who were participants of a large cross-sectional study comprising three disease defined cohorts. Serum 25(OH)D was measured by liquid chromatography mass spectroscopy. Associations between 25(OH)D and potential confounders were explored in forward regression models in each cohort. RESULTS the three cohorts comprised 1895, 1233 and 1316 participants (respective mean ages 70.1, 71.0 and 80.4 years). Statistical models explained between a fifth to a third of the variation in 25(OH)D. Supplement use and global solar radiation were positive predictors of 25(OH)D in all cohorts whereas the only universal negative predictor was body mass index. Supplement use was associated with a mean increase in 25(OH)D of between 21.4 and 35.4 nmol/l. The other main predictors varied by cohort but included sun holiday travel, enjoyment of sunshine when outside, use of vitamin D fortified milk, smoking, oily fish and egg consumption and physical frailty. CONCLUSION supplement use was the most important determinant of vitamin D status. Vitamin D fortified milk and spending time in the sun, even in the oldest old may also be useful strategies to improve 25(OH)D.
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Affiliation(s)
- Kevin McCarroll
- Department of Gerontology, St James's Hospital, Dublin, Ireland Mercers Institute for Research on Ageing, Dublin, Ireland
| | - Avril Beirne
- Mercers Institute for Research on Ageing, Dublin, Ireland
| | - Miriam Casey
- Department of Gerontology, St James's Hospital, Dublin, Ireland
| | - Helene McNulty
- Centre for Food and Health, University of Ulster, Derry, Northern Ireland, UK
| | - Mary Ward
- Centre for Food and Health, University of Ulster, Derry, Northern Ireland, UK
| | - Leane Hoey
- Centre for Food and Health, University of Ulster, Derry, Northern Ireland, UK
| | - Anne Molloy
- Institute of Molecular Medicine, Trinity College Dublin, Ireland
| | - Eamon Laird
- Institute of Molecular Medicine, Trinity College Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, St James's Hospital, Dublin, Ireland
| | - J J Strain
- Centre for Food and Health, University of Ulster, Derry, Northern Ireland, UK
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Clarke M, Ward M, Dickey W, Hoey L, Molloy AM, Waldron L, Varghese A, McCann A, Blayney JK, McNulty H. B-vitamin status in relation to bone mineral density in treated celiac disease patients. Scand J Gastroenterol 2015; 50:975-84. [PMID: 25861707 DOI: 10.3109/00365521.2015.1015603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Patients with celiac disease (CD) are at increased risk of osteoporosis and compromised B-vitamin status. Emerging evidence supports a beneficial role of folate and the metabolically related B-vitamins in bone health in generally healthy adults, but no previous study has investigated this in CD patients. The aim of the current study was to examine the relationship of folate, vitamins B12, B6 and B2 (riboflavin), and the related metabolite homocysteine, with bone mineral density (BMD) in CD patients. MATERIALS AND METHODS Of the 400 treated adult CD patients invited to participate, 110 responded and met the eligibility criteria for study participation. BMD was measured using dual energy X-ray absorptiometry scanning at the lumbar spine (L1-L4), femoral neck, and total hip sites. Biomarker status of the relevant B-vitamins and homocysteine, and dietary B-vitamin intakes, were measured. RESULTS The significant predictors of low BMD were increasing age (B = 0.080, p < 0.001) and decreasing weight (B = 0.072, p = 0.004), whereas no significant relationship with serum 25-hydroxyvitamin D (B = 0.093, p = 0.928) was observed. Following adjustment for these predictors, serum vitamin B12 (but no other B-vitamin biomarker) was found to be a significant determinant of BMD at the femoral neck (β = 0.416, p = 0.011) and total hip (β = 0.327, p = 0.049) in men only. No significant relationships were found between any of the B-vitamin biomarkers investigated and BMD (at any measured site) in women. CONCLUSION These findings add to current evidence suggesting a potential role of vitamin B12 in BMD, particularly in men, and show such a relationship for the first time in CD patients.
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Affiliation(s)
- Michelle Clarke
- Northern Ireland Centre for Food and Health, University of Ulster , Coleraine , Northern Ireland
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Laird E, McNulty H, Ward M, Hoey L, McSorley E, Wallace JMW, Carson E, Molloy AM, Healy M, Casey MC, Cunningham C, Strain JJ. Vitamin D deficiency is associated with inflammation in older Irish adults. J Clin Endocrinol Metab 2014; 99:1807-15. [PMID: 24606079 DOI: 10.1210/jc.2013-3507] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Inadequate vitamin D status is common within elderly populations and may be implicated in the etiology of autoimmune disease and inflammation. Few studies have investigated the relationship between vitamin D status and age-related immune dysfunction in humans. OBJECTIVE The aim of this study was to investigate the association between vitamin D status and immune markers of inflammation in a large sample of older adults. DESIGN, SETTING, AND PARTICIPANTS An observational investigation of 957 Irish adults (>60 years of age) recruited in Northern Ireland (55°N latitude) as part of the Trinity Ulster Department of Agriculture aging cohort study. MAIN OUTCOME MEASURE We measured serum 25-hydroxyvitamin D (25(OH)D) by liquid chromatography tandem mass spectrometry and serum cytokines IL-6, TNF-α, IL-10, and C-reactive protein (CRP) by ELISA. RESULTS Concentrations of IL-6, CRP, and the ratios of IL-6 to IL-10 and CRP to IL-10 were significantly higher in individuals with deficient (<25 nmol/L) serum 25(OH)D compared with those with sufficient (>75 nmol/L) status after adjustment for age, sex, and body mass index (P < .05). Vitamin D status was a significant predictor of the IL-6 to IL-10 cytokine ratio, and those participants defined as deficient were significantly more likely to have an IL-6 to IL-10 ratio >2:1 compared with those defined as sufficient. CONCLUSIONS This study demonstrated significant associations between low vitamin D status and markers of inflammation (including the ratio of IL-6 to IL-10) within elderly adults. These findings suggest that an adequate vitamin D status may be required for optimal immune function, particularly within the older adult population.
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Affiliation(s)
- E Laird
- Institute of Molecular Medicine (E.L., A.M.M.), School of Medicine, Trinity College, Dublin, Ireland; Northern Ireland Centre for Food and Health (H.M., M.W., L.H., E.M., J.M.W.W., E.C., J.J.S.), University of Ulster, Coleraine, Londonderry BT52 1SA, Northern Ireland; Department of Clinical Biochemistry (M.H.), St James's Hospital, Dublin, Ireland; and The Mercers Institute for Research on Ageing (M.C.C., C.C.), St James's Hospital, Dublin, Ireland
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Abstract
In most countries, the dietary folate intake associated with adequate status of red cell folate and/or serum folate provides the basis for formulating reference values. One of the major challenges in setting dietary reference values for folate, however, is the need to account for the differences in bioavailability between the natural forms of the vitamin and the synthetic form, folic acid, albeit to date, few countries in Europe take bioavailability into consideration. A series of systematic reviews that included only those studies which used the most robust measures of both folate intake and folate status were carried out by the EURRECA Network of Excellence to examine the relationships between folate intake, status, and a number of health outcomes relevant to specific stages of the lifecycle. This review summarizes the available evidence and the issues to consider in the setting of dietary reference values for folate.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, United Kingdom.
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Duffy ME, Hoey L, Hughes CF, Strain JJ, Rankin A, Souverein OW, Dullemeijer C, Collings R, Hooper L, McNulty H. Biomarker responses to folic acid intervention in healthy adults: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2014; 99:96-106. [PMID: 24225357 DOI: 10.3945/ajcn.113.062752] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The task of revising dietary folate recommendations for optimal health is complicated by a lack of data quantifying the biomarker response that reliably reflects a given folate intake. OBJECTIVE We conducted a dose-response meta-analysis in healthy adults to quantify the typical response of recognized folate biomarkers to a change in folic acid intake. DESIGN Electronic and bibliographic searches identified 19 randomized controlled trials that supplemented with folic acid and measured folate biomarkers before and after the intervention in apparently healthy adults aged ≥18 y. For each biomarker response, the regression coefficient (β) for individual studies and the overall pooled β were calculated by using random-effects meta-analysis. RESULTS Folate biomarkers (serum/plasma and red blood cell folate) increased in response to folic acid in a dose-response manner only up to an intake of 400 μg/d. Calculation of the overall pooled β for studies in the range of 50 to 400 μg/d indicated that a doubling of folic acid intake resulted in an increase in serum/plasma folate by 63% (71% for microbiological assay; 61% for nonmicrobiological assay) and red blood cell folate by 31% (irrespective of whether microbiological or other assay was used). Studies that used the microbiological assay indicated lower heterogeneity compared with studies using nonmicrobiological assays for determining serum/plasma (I(2) = 13.5% compared with I(2) = 77.2%) and red blood cell (I(2) = 45.9% compared with I(2) = 70.2%) folate. CONCLUSIONS Studies administering >400 μg folic acid/d show no dose-response relation and thus will not yield meaningful results for consideration when generating dietary folate recommendations. The calculated folate biomarker response to a given folic acid intake may be more robust with the use of a microbiological assay rather than alternative methods for blood folate measurement.
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Affiliation(s)
- Maresa E Duffy
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland (MED, L Hoey, CFH, JJS, AR, and HM); the Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, Netherlands (OWS and CD); and Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (RC and L Hooper)
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Abstract
A compromised vitamin B12 status is common in older people despite dietary intakes that typically far exceed current recommendations. The maintenance of an optimal status of vitamin B12 is not only dependent on adequate dietary intake but more critically on effective absorption which diminishes with age. The measurement of vitamin B12 is complicated by the lack of a gold standard assay. There are a number of direct and functional indicators of vitamin B12 status; however, none of these are without limitations and should be used in combination. Vitamin B12 is of public health importance, not only because deficiency leads to megaloblastic anaemia and irreversible nerve damage, but also because emerging evidence links low B12 to an increased risk of a number of age-related diseases, including cardiovascular disease, cognitive dysfunction, dementia and osteoporosis. Furthermore, there are concerns relating to potential adverse effects for older adults with low vitamin B12 status of over-exposure to folic acid in countries where there is mandatory fortification of food with folic acid. The aim of this review is to examine the known and emerging issues related to vitamin B12 in ageing, its assessment and inter-relationship with folate.
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Affiliation(s)
- Catherine F Hughes
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Mary Ward
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Leane Hoey
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Helene McNulty
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
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McGlynn AP, Wasson GR, O'Reilly SL, McNulty H, Downes CS, Chang CK, Hoey L, Molloy AM, Ward M, Strain JJ, McKerr G, Weir DG, Scott JM. Low colonocyte folate is associated with uracil misincorporation and global DNA hypomethylation in human colorectum. J Nutr 2013; 143:27-33. [PMID: 23190761 DOI: 10.3945/jn.112.167148] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Low folate status is a risk factor for colon carcinogenesis; mechanisms proposed to account for this relationship include uracil misincorporation into DNA and global DNA hypomethylation. We investigated whether such biomarkers are related to folate status in isolated colonocytes from colonoscopy patients. In cases with adenomatous polyps (n = 40) or hyperplastic polyps (n = 16), colonocytes were isolated from biopsies from the polyp, from a site adjacent to the polyp, and from normal mucosa 10-15 cm distal to the polyp. In polyp-free controls (n = 53), biopsies were taken from ascending, transverse, and descending areas of colon. Within adenoma cases, there was a trend (P-trend < 0.001) of decreasing colonocyte folate (pg/10⁵ cells, mean ± CI) from the site distal to the polyp (16.9 ± 2.4), to the site adjacent to the polyp (14.7 ± 2.3), to the polyp (12.8 ± 2.0). Correspondingly, there were increases in uracil misincorporation (P-trend < 0.001) and global DNA hypomethylation (P-trend = 0.012) across the 3 sites. Colonocyte folate concentrations were significantly correlated with RBC folate concentrations, but only in individuals with generally lower (≤484 μg/L) RBC folate status (r = 0.54; P = 0.006; n = 24), and were also significantly lower in normal mucosa of cases with adenomatous polyps than in controls matched for colonic segment. In conclusion, localized folate deficiency in specific areas of colon might create carcinogenic fields and affect the development of colorectal polyps through uracil misincorporation and DNA hypomethylation; alternatively, the polyp itself might deplete folate in the surrounding tissue. Folate supplementation trials aimed at colon cancer prevention should target individuals with suboptimal folate status.
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Affiliation(s)
- Angela P McGlynn
- Centre for Molecular Biosciences, University of Ulster, Coleraine, Northern Ireland
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Abstract
Scientific evidence supports a number of roles for folate in maintaining health from early life to old age. Folate is required for one-carbon metabolism, including the remethylation of homocysteine to methionine; thus elevated plasma homocysteine reflects functional folate deficiency. Optimal folate status has an established role in preventing NTD and there is strong evidence indicating that it also has a role in the primary prevention of stroke. The most important genetic determinant of homocysteine in the general population is the common 677C → T variant in the gene encoding the folate-metabolising enzyme, MTHFR; homozygous individuals (TT genotype) have reduced enzyme activity and elevated plasma homocysteine concentrations. Meta-analyses indicate that the TT genotype carries a 14 to 21 % increased risk of CVD, but there is considerable geographic variation in the extent of excess CVD risk. A novel interaction between this folate polymorphism and riboflavin (a co-factor for MTHFR) has recently been identified. Intervention with supplemental riboflavin targeted specifically at individuals with the MTHFR 677TT genotype was shown to result in significant lowering of blood pressure in hypertensive people and in patients with CVD. This review considers the established and emerging roles for folate throughout the lifecycle, and some public health issues related to optimising folate status.
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Affiliation(s)
- Helene McNulty
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, UK
| | - Kristina Pentieva
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, UK
| | - Leane Hoey
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, UK
| | - JJ Strain
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, UK
| | - Mary Ward
- Northern Ireland Centre for Food and Health (NICHE), University of Ulster, Coleraine, UK
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Pelletier DL, Frongillo EA, Gervais S, Hoey L, Menon P, Ngo T, Stoltzfus RJ, Ahmed AMS, Ahmed T. Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative. Health Policy Plan 2011; 27:19-31. [DOI: 10.1093/heapol/czr011] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND National survey data of erythrocyte glutathione reductase activation coefficient (EGRac) indicate that suboptimal riboflavin status may be a problem in all population age groups, but the cutoff for deficiency is controversial. In addition, the effectiveness of different biomarkers of riboflavin status has not been critically evaluated. OBJECTIVE We aimed to assess the effectiveness of different biomarkers of riboflavin status through a systematic review of published riboflavin supplementation trials. DESIGN We structured our search strategy on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases; formal inclusion and exclusion criteria; data extraction; validity assessment; and meta-analysis. RESULTS Eighteen supplementation studies reporting up to 14 biomarkers were included. Sufficient data were available to show that EGRac (14 studies) and basal glutathione reductase activity (5 studies) were effective biomarkers of altered riboflavin intake (P < 0.00001), although substantial heterogeneity (I2 > 66%) that could not be explained by the subgroup analysis was observed. Plasma total homocysteine was not an effective biomarker of riboflavin status in the general population, but some evidence identified its potential usefulness specifically in those homozygous for a common polymorphism in the MTHFR gene. CONCLUSIONS The evidence suggests that EGRac is an effective biomarker of a change in riboflavin intake in populations with severe-to-normal baseline status. Studies of healthy populations that compare the response to low-dose supplementation among different age, sex, and MTHFR genotype groups are required to provide evidence for generating dietary riboflavin recommendations specific to different population subgroups. Further research into alternative biomarkers to EGRac is also required.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, United Kingdom.
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Hoey L, Strain JJ, McNulty H. Studies of biomarker responses to intervention with vitamin B-12: a systematic review of randomized controlled trials. Am J Clin Nutr 2009; 89:1981S-1996S. [PMID: 19403638 DOI: 10.3945/ajcn.2009.27230c] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Mild vitamin B-12 deficiency is common among older adults, but evidence for setting dietary recommendations is limited because most studies have administered vitamin B-12 via nonoral routes or at doses several hundred times higher than current recommendations. Furthermore, different biomarkers of vitamin B-12 status have not been systematically reviewed. OBJECTIVE The aim was to assess the effectiveness of biomarkers of vitamin B-12 status through a systematic review of published randomized controlled trials of oral vitamin B-12 supplementation. DESIGN Methods included a structured search strategy on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases; formal inclusion and exclusion criteria; data extraction; validity assessment; and meta-analysis. RESULTS Eight randomized controlled trials were included, and all studies measured serum and plasma total vitamin B-12, 3 studies measured methylmalonic acid, and 6 studies measured total homocysteine response. All 3 biomarkers were found to be effective measures of altered vitamin B-12 intake in populations with low and borderline baseline vitamin B-12 status (P < 0.00001); however, in the case of total vitamin B-12, substantial heterogeneity that could not be fully explained by subgroup analysis was observed. Insufficient data were available to determine the effectiveness of plasma holotranscobalamin, which was measured in only one randomized controlled trial. CONCLUSIONS The available evidence suggests that plasma and serum concentrations of total vitamin B-12, methylmalonic acid, and total homocysteine are all effective biomarkers of a change in vitamin B-12 intake; however, because the available data were limited, it was not possible to examine fully the factors that could explain the substantial heterogeneity in total vitamin B-12. Future trials should include low-dose vitamin B-12 in adults across the entire age spectrum and measure the holotranscobalamin response to supplementation.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, United Kingdom.
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Halferty L, Brennan GP, Trudgett A, Hoey L, Fairweather I. Relative activity of triclabendazole metabolites against the liver fluke, Fasciola hepatica. Vet Parasitol 2008; 159:126-38. [PMID: 19027238 DOI: 10.1016/j.vetpar.2008.10.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 09/17/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
Abstract
A study has been carried out to determine the relative activity of triclabendazole (TCBZ) and its sulphoxide (TCBZSO) and sulphone (TCBZSO(2)) metabolites against the adult stage of the liver fluke, Fasciola hepatica. Flukes were incubated for 24h in vitro in 15mug/ml of each of the compounds and prepared for scanning and transmission electron microscopy. All three compounds induced changes to the surface morphology of the fluke, the changes comprising swelling and blebbing to a greater or lesser extent in different regions of the fluke. TCBZSO(2) was more disruptive anteriorly and TCBZSO posteriorly. Internal ultrastructural changes were evident following incubation with each of the compounds, with an order of severity TCBZSO(2)>TCBZSO>TCBZ. Swelling of the basal infolds and mitochondria were observed in the tegumental syncytium. In the tegumental cell bodies, there was a reduction in the number of secretory bodies, disruption of the Golgi complexes and swelling of the mitochondria. Severe flooding of the internal tissues was observed with TCBZSO(2) and, to a lesser extent, with TCBZSO and TCBZ. The results demonstrate that both TCBZ and TCBZSO(2) are capable of disrupting the fluke in vitro and are not the inactive compounds they were assumed to be previously. They may well contribute to drug action in vivo as well, indicating that drug action is due to the additive effects of several metabolites, rather than being due to a single active metabolite, namely, TCBZSO.
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Affiliation(s)
- L Halferty
- Parasite Proteomics and Therapeutics Research Group, School of Biological Sciences, The Queen's University of Belfast, Belfast BT9 7BL, United Kingdom
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Hoey L, McNulty H, Askin N, Dunne A, Ward M, Pentieva K, Strain J, Molloy AM, Flynn CA, Scott JM. Effect of a voluntary food fortification policy on folate, related B vitamin status, and homocysteine in healthy adults. Am J Clin Nutr 2007; 86:1405-13. [PMID: 17991653 DOI: 10.1093/ajcn/86.5.1405] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mandatory folic acid fortification of food is effective in reducing neural tube defects and may even reduce stroke-related mortality, but it remains controversial because of concerns about potential adverse effects. Thus, it is virtually nonexistent in Europe, albeit many countries allow food fortification on a voluntary basis. OBJECTIVE The objective of the study was to examine the effect of a voluntary but liberal food fortification policy on dietary intake and biomarker status of folate and other homocysteine-related B vitamins in a healthy population. DESIGN The study was a cross-sectional study. From a convenience sample of 662 adults in Northern Ireland, those who provided a fasting blood sample and dietary intake data were examined (n = 441, aged 18-92 y). Intakes of both natural food folate and folic acid from fortified foods were estimated; we used the latter to categorize participants by fortified food intake. RESULTS Fortified foods were associated with significantly higher dietary intakes and biomarker status of folate, vitamin B-12, vitamin B-6, and riboflavin than were unfortified foods. There was no difference in natural food folate intake (range: 179-197 microg/d) between the fortified food categories. Red blood cell folate concentrations were 387 nmol/L higher and plasma total homocysteine concentrations were 2 micromol/L lower in the group with the highest fortified food intake (median intake: 208 microg/d folic acid) than in the nonconsumers of fortified foods (0 microg/d folic acid). CONCLUSIONS These results show that voluntary food fortification is associated with a substantial increase in dietary intake and biomarker status of folate and metabolically related B vitamins with potential beneficial effects on health. However, those who do not consume fortified foods regularly may have insufficient B vitamin status to achieve the known and potential health benefits.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, United Kingdom.
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McKillop DJ, McNulty H, Scott JM, McPartlin JM, Strain JJ, Bradbury I, Girvan J, Hoey L, McCreedy R, Alexander J, Patterson BK, Hannon-Fletcher M, Pentieva K. The rate of intestinal absorption of natural food folates is not related to the extent of folate conjugation. Am J Clin Nutr 2006; 84:167-73. [PMID: 16825692 DOI: 10.1093/ajcn/84.1.167] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence is conflicting as to whether the bioavailability of food folates is influenced by the extent of their conjugation. OBJECTIVE The objective was to compare the bioavailability of 3 representative food folate sources with various degrees of glutamylation-ie, egg yolk, spinach, and yeast, whose polyglutamyl folate content measured 0%, 50%, and 100%, respectively. DESIGN In a randomized crossover trial, 13 male subjects, after a prestudy folate saturation procedure, received in random order either placebo or 500 mug total folate, which was provided as concentrated freeze-dried extract removed from the normal food matrix of egg yolk, spinach, or yeast. Blood samples (n = 10) were collected before and up to 10 h after treatments, which were administered at weekly intervals. RESULTS A significant increase from baseline plasma folate concentrations was observed by 0.5 h after treatment with egg yolk folate or spinach folate and by 1 h after treatment with yeast folate, and the concentrations remained significantly elevated for 3-5 h; no plasma folate response was observed after placebo treatment. The overall responses, calculated as plasma folate area under the curve (AUC) for egg yolk, spinach, and yeast folate, were 122.6 +/- 23.6, 136.2 +/- 21.4, and 102.5 +/- 21.1 nmol . h/L, respectively. No significant differences in AUC were seen between monoglutamyl (egg yolk) folate and either of the polyglutamate-containing folates examined. CONCLUSION These results suggest that the ratio of monoglutamate to polyglutamate in natural folates is not a factor that limits the extent of intestinal absorption of food folate.
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Affiliation(s)
- Derek J McKillop
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, United Kingdom
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Hoey L, Rowland IR, Lloyd AS, Clarke DB, Wiseman H. Influence of soya-based infant formula consumption on isoflavone and gut microflora metabolite concentrations in urine and on faecal microflora composition and metabolic activity in infants and children. Br J Nutr 2004; 91:607-16. [PMID: 15035688 DOI: 10.1079/bjn20031083] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The urinary excretion of soya isoflavones and gut microflora metabolites was investigated in infants and children who had been fed soya-based infant formulas in early infancy. These infants and children were compared with cows'-milk formula-fed controls, to determine at what age gut microflora metabolism of daidzein to equol and/or O-desmethylangolensin (O-DMA) was established, and whether exposure to isoflavones in early infancy influences their metabolism at a later stage of development. Sixty infants and children (aged 4 months-7 years) participated in the study; thirty in each of the soya and control groups. There were four age groups. These were: 4-6 months (seven in the soya group and seven in the control group); 7-12 months (seven in the soya group and nine in the control group); 1-3 years (six in the soya group and eight in the control group); 3-7 years (ten in the soya group and six in the control group). Urine samples were collected to measure isoflavonoids by MS, and faecal samples were collected to measure gut-health-related bacterial composition, by fluorescent in situ hybridisation with oligonucleotide probes, and metabolic activity. A soya challenge (typically a soya yoghurt alternative product containing 4.8 g soya protein and on average 22 mg total isoflavones) was given to control-group infants (>6 months) and children, and also to soya-group children that were no longer consuming soya, to determine their ability to produce equol and/or O-DMA. Urinary genistein, daidzein and glycitein were detected in all infants (4-6 months) fed soya-based infant formula; O-DMA was detected in 75 % of infants but equol was detected in only 25 %. In the controls (4-6 months), urinary isoflavonoids were very low or not detected. In the older age groups (7 months-7 years), O-DMA was found in the urine samples of 75 % of the soya group and 50 % of the controls, after the soya challenge. Equol excretion was detected in 19 % of the soya-group infants and children, and in only 5 % of the controls. However, in the oldest (3-7 years) children, the proportion excreting O-DMA and equol was similar in both groups. Faecal bacterial numbers for bifidobacteria (P<0.001), bacteroides and clostridia (P<0.05) were significantly lower for the soya group compared with the control group. There appears to be no lasting effect of early-life isoflavone exposure on isoflavone metabolism.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, UK
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Affiliation(s)
- M E E McCann
- Agricultural, Food and Environmental Science Division, Department of Agriculture and Rural Development of Northern Ireland
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