Abstract
Aim: To evaluate the dietary calcium and vitamin D status in south Indian postmenopausal women. Methods: Postmenopausal women (n=164) were evaluated for their daily dietary calcium intake, phytate to calcium ratio, and bone mineral parameters. Their serum leutinizing hormone (LH), follicle-stimulating hormone (FSH), 25-hydroxyvitamin D (25[OH]D), and parathyroid hormone levels (PTH) were measured. Results: Their age and BMI were 59.5 ± 8 years and 27 ± 5 kg/m2, respectively. Their daily dietary intake of calcium was 323 ± 66 mg/day; phytate to calcium ratio, 0.56±0.1; LH, 26 ± 13.5 µIU/l; and FSH, 62.6 ± 30 µIU/l. Their dietary intake of calcium was low compared with the recommended daily/dietary allowance (RDA) of the Indian Council of Medical Research (ICMR) for the Indian population. Of the 164 patients studied, based on population-based reference values, 126 (77%) had normal 25(OH)D levels (9–37.6 ng/ml), and 38 (23%) had 25(OH)D deficiency. Using functional health-based reference values, 30 (18%) patients had normal 25(OH)D levels (>20 ng/ml), 85 (52%) had 25(OH)D insufficiency (10–20 ng/ml), and 49(30%) had 25(OH)D deficiency (<10 ng/ml). PTH and serum alkaline phosphatase (SAP) was significantly high in patients with 25(OH)D deficiency (p<0.05) compared with those with normal 25(OH)D levels. There was a negative correlation between 25(OH)D and PTH (r=−0.2; p<0.007) and SAP (r=−0.2; p<0.001). Dietary calcium correlated positively with dietary phosphates (r=0.8; p<0.001) and phytate to calcium ratio (r=0.75; p<0.001). Conclusions: Population-based reference values underdiagnosed vitamin D insufficiency and overdiagnosed normal vitamin D status. The diet was insufficient in calcium and high in phytate. About 82% of the study group had varying degrees of low 25-hydroxyvitamin D levels. The quality of diet has to be improved with enrichment/supplementation of calcium and vitamin D to suppress secondary hyperparathyroidism-induced bone loss and risk of fractures.
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References
Lips P, Chapuy MC, Dawson-Hughes B, Pols HAP, Holick MF (1999) International comparison of vitamin D measurements. Osteoporos Int 9:394–397
Hollis BW (2000) Comparison of commercially available125I-based RIA methods for determination of circulating 25-hydroxyvitamin D. Clin Chem 46:1657–1661
Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D synthesis in human skin. J Clin Endocrinol Metab 67:373–378
Matsuoka LY, Worstman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF (1992) Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D. J Clin Endocrinol Metab 75:1099–1103
Clemens TL, Adams JS, Henderson SL, Holick MF (1982) Increased skin pigment reduces the capacity of skin to synthesis vitamin D3. Lancet 1:74–75
Need AG, Morris HA, Horowitz M, Nordin BEC (1993) Effects of skin thickness, age, body fat and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr 58:882–885
Agarwal KS, Mughal MZ, Upadhyay P, Berry JL, Marwer EB, Puliyel JM (2002) The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 87:111–113
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S et al (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443
Dawson-Hughes B (1996) Calcium, vitamin D and vitamin D metabolites. In: Papapoulos SE, Lips P, Pols HAP, Hohnston CC, Delmas PD (eds) Osteoporosis. Proceedings of the 1996 world congress on osteoporosis. Elsevier International Congress Series, no. 118. Elsevier, Amsterdam, pp 229–303
Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer P, Whedon G (1982) Vitamin D and bone disease in the elderly. Am J Clin Nutr 32:1014–1031
Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501
Harinarayan CV (2004) What’s in a name: 25(OH)D or 25(OH)D3? Natl Med J India 17(2):114–115
Luckert B, Higgins J, Stoskopf M (1992) Menopausal bone loss is partially regulated by dietary intake of vitamin D. Calcif Tissue Int 51:173–179
Villareal DT, Civitelli R, Chines A, Avioli LV (1991) Sub-clinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. J Clin Endocrinol Metab 72:628–634
Holick MF (2000) Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 9:87–98
Harris SS, Soteriades E, Stina Coolidge JA, Mudgal S, Hughes BD (2001) Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab 85:4125–4130
Gopalan C, Ramasastry BV, Balasubramanyam SC (1996) Nutritive value of Indian foods. National Institute of Nutrition, Hyderabad
Incstar (date unknown) Instruction manual: 25-hydroxyvitamin D125I RIA kit. Diasorin Incstar, Stillwater, MN, p 10
Parfitt AM, Mathews C, Rao D, Frame B, Kleerkoper M, Villanueava AR (1981) Impaired osteoblast function in metabolic bone disease. In: DeLuca HF, Frost HM, Jee WSS, Johnston CC, Parfitt AM (eds) Osteoporosis, recent advances in pathogenesis and treatment. University Park Press, Baltimore, pp 321–330
Chapuy MC, Chapuy P, Meunier PJ (1987) Calcium and vitamin D supplements: effects on calcium metabolism in elderly people. Am J Clin Nutr 46:324–328
Bischoff HA., Stahelin HB, Dick W, Akos R, Knecht M, Salis C et al (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Min Res 18:343–351
Heaney RP (2003) Vitamin D depletion and effective calcium absorption. A letter to the editor. J Bone Min Res18:1342
Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22:142–146
Panwar B, Punia D (2000) Analysis of composite diets of rural pregnant women and comparison with calculated values. Nutr Health 14:217–223
Chapuy MC, Arlot ME, Duboeuf F, Crouzet B, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in elderly women. N Eng J Med 327:1637–1642
Chapuy MC, Arlot ME, Delmas PD, Meunier PJ (1994). Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 308:1081–1082
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Eng J Med 387:670–676
Chapuy MC, Pamphill R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ (2002) Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int 18:257–264
Trivedi D P, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholechaciferol) supplementation on fractures and mortality in men and women living in the community: double blind controlled trials. BMJ 386:469–472
Harinarayan CV, Gupta N, Kochupillai N (1995) Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol (Oxf) 43:351–358
Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N (2000) Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 72:472–475
Joshi SR (1999) Hypovitaminosis D in patients attending a rheumatology clinic at a tertiary referral clinic. J Assoc Physicians India 47:463–464
Tandon N, Marwaha RK, Kalra S, Gupta N, Dudha A, Kochupillai N (2003) Bone mineral parameters in healthy young Indian adults with optimal vitamin D availability. Nat Med J India 16:298–302
Arya V, Bhambri R, Godbole MM, Mithal A (2004) Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int 15(1):56–61
Prince RL, Dick I, Devine A, Price RI, Gutteridge DH, Kerr D et al (1995) The effect of menopause and age on calcitropic hormones: a cross sectional study of 655 healthy women aged 35 to 90. J Bone Miner Res 10:835–842
Brazier M, Kamel S, Maamer M, Agbomson F, Elesper I, Garabedian M et al (1995) The markers of bone remodeling in the elderly subjects: effects of vitamin D insufficiency and its correction. J Bone Miner Res 10:1753–1761
Greenspan SL, Martian LA, Myers ER, Krasnow MB, Kido TH (1994) Femoral bone loss progresses with age: a longitudinal study in women over age 65. J Bone Miner Res 9:1959–1965
Ensrud KE, Paiermo L, Black D, Cauley J, Jergas M, Orwoll ES et al (1995) Hip and calcaneal bone loss with advancing age: longitudinal results or the study of osteoporotic fractures. J Bone Miner Res 10:1778–1787
Mezquita-Raya P, Munoz-Torres M, Luna JDD, Luna V, Lopez-Rodriguez P, Torres-Vela E et al (2001) Relationship between vitamin D insufficiency, bone density and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1415
Sahota O, Gaynor K, Harwood RH, Hosking DJ (2001) Hypovitaminosis D and ‘functional hypoparathyroidism’: the NoNoF (Nottingham Neck of Femur) study. Age Ageing 30:467–472
Szulc P, Meunier PJ (2003) Synergistic effect of vitamin D and calcium in preventing proximal femoral fractures in older patients. Joint Bone Spine 70:157–160
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Harinarayan, C.V. Prevalence of vitamin D insufficiency in postmenopausal south Indian women. Osteoporos Int 16, 397–402 (2005). https://doi.org/10.1007/s00198-004-1703-5
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DOI: https://doi.org/10.1007/s00198-004-1703-5