Applied nutritional investigationSeemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from a Mediterranean area
Introduction
Vitamin D deficiency has been found to be prevalent among elderly populations in many regions of the world [1], [2], [3], [4], [5], [6]. In community-dwelling elderly people, the prevalence of vitamin D deficiency is 5–25% and this is much greater (48–80%) in the institutionalized elderly population [7], [8], [9], [10].
Vitamin D is produced endogenously when the skin is exposed to sunlight (ultraviolet B 290–315 nm) and can be obtained exogenously from a few natural food sources and by food fortification and supplements. Several factors potentially affect vitamin D status. These include genetic factors, adiposity, and factors affecting the cutaneous synthesis of vitamin D such as skin pigmentation, age, season, latitude, melanin concentration, clothing, and use of sunscreens [11]. Elderly people are prone to vitamin D deficiency because of various risk factors including decreased dietary intake, diminished sunlight exposure, reduced skin thickness, impaired intestinal absorption, and impaired hydroxylation in the liver and kidneys [12], [13]. In addition, several studies carried out in elderly people have revealed a poorer vitamin D status during the autumn and winter because of the lower sunlight exposure during these months [2], [14], [15], [16], [17].
An inadequate vitamin D status is associated with increased bone turnover and bone loss, which increases fall and fracture risks. This condition is also related to muscle weakness and more recently to the risk of colorectal, breast, ovarian, and prostate cancers and type 1 diabetes and heart disease [18], [19], [20], [21], [22], [23]. Vitamin D and calcium supplementation has been shown to contribute to the prevention of hip and non-vertebral fractures in elderly women and men [14], [24], [25], [26], [27], [28].
It is well recognized that elevated serum parathyroid hormone concentrations and low 25-hydroxyvitamin D (25[OH]D) levels are common indicators of vitamin D deficiency. Serum or plasma 25(OH)D concentration is considered an appropriate measurement of vitamin D status [11], [29]. The limit for optimal 25(OH)D concentrations is still unclear, with levels ranging from 20 to 122 nmol/L to prevent secondary hyperparathyroidism [30], [31], [32], [33]. We chose to operate with limits of 25 nmol/L for vitamin D deficiency and 50 nmol/L for insufficiency, in agreement with previous studies [2].
The aim of the present study was to determine vitamin D status (assessed by measuring serum concentrations of 25[OH]D) in elderly nursing-home subjects from the province of Murcia, a Mediterranean area in southeast Spain, and the relation to season and other factors, namely age, gender, dietary intake, vitamin D supplements, nutritional status, functional ability, cognitive function, and disease.
Section snippets
Subjects
The cross-sectional study was carried out in the province of Murcia (southeast Spain) between May 2005 and October 2006. The age of the subjects ranged from 65 to 94 y and all lived in three public nursing homes from urban areas. Only subjects who had a normal diet were included (subjects who had enteral or parenteral nutrition or pureed foods were excluded). From a total of 464 subjects living in the three nursing homes studied, 143 (30.8%) consumed a normal diet and/or were not severely
Results
The mean characteristics of the subjects studied are summarized in Table 1. The number and age of the subjects were significantly higher for women than for men and proportional to the subjects living in the three nursing homes studied (data not shown).
The mean BMI value of the subjects (28.8 ± 5.8 kg/m2) was within the normal range for elderly populations (24–29 kg/m2).
The mean MNA score was 23.6 ± 4.0; according to the classification of the MNA test, our subjects were not malnourished or at
Discussion
The BMI for elderly populations should be 24–29 kg/m2[44]; in the present study, the mean BMI value of the subjects was within this range but at the highest values of normality (28.8 ± 5.8 kg/m2).
The median daily dietary intake of energy, proteins, and calcium exceeded the recommended dietary intake for Spanish elderly people [40].
The results concerning average daily dietary intake of energy, proteins, and calcium, in addition to BMI and MNA, suggest that the studied subjects can be considered
References (52)
- et al.
Serum vitamin D concentrations among elderly people in Europe
Lancet
(1995) - et al.
Vitamin D insufficiency in North America
J Nutr
(2005) - et al.
Effects of diet and exercise on plasma vitamin D (25(OH)D) levels in Vietnamese immigrant elderly in Sydney, Australia
J Steroid Biochem Mol Biol
(2007) Vitamin D status and nutrition in Europe and Asia
J Steroid Biochem Mol Biol
(2007)Differences in vitamin D status between countries in young adults and the elderly
Am J Med
(1992)- et al.
Contributions of vitamin D and sunlight exposure to plasma 25-hydroxyvitamin D concentration in elderly women
Am J Clin Nutr
(1994) - et al.
Serum calcidiol and calcitriol concentrations in elderly people: variations with age, sex, season and disease
Clin Nutr
(1996) Beneficial effects of sun exposure on cancer mortality
Prev Med
(1993)- et al.
Vitamin D deficiency, muscle function, and falls in elderly people
Am J Clin Nutr
(2002) Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis
Am J Clin Nutr
(2004)
Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes1
Am J Clin Nutr
Redefining vitamin D insufficiency
Lancet
Dietary calcium and vitamin D intake in elderly women: effect on serum parathyroid hormone and vitamin D metabolites
Am J Clin Nutr
Vitamin D status: effects on parathyroid hormone and 1,25-dihydroxyvitamin D in postmenopausal women
Am J Clin Nutr
Validation of a radioreceptor assay for 1,25-dihydroxyvitamin D using selected ion monitoring GC-MS
Clin Chim Acta
At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk
Clin Nutr
Rates of bone loss in postmenopausal women randomly assigned to one of two dosages of vitamin D
Am J Clin Nutr
Nutrition in the elderly
Best Pract Res Clin Gastroenterol
Undernutrition in medical outpatients
Clin Geriatr Med
Teenage girls and elderly women living in northern Europe have low winter vitamin D status
Eur J Clin Nutr
Vitamin D deficiency in the elderly in Athens, Greece
J Bone Miner Metab
Seasonal prevalence of vitamin D deficiency in institutionalized alder adults
J Am Geriatr Soc
A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial
J Clin Endocrinol Metab
Malnutrición en personas mayores de Europa: situación en España
Cited by (34)
Influencing variables on total and free 25(OH)D levels in healthy population
2022, Revista Clinica EspanolaThe Effect of Sun Light Exposure to the Level of Vitamin D in Elderly People Living in Nursing Home
2022, Journal of Clinical DensitometryCitation Excerpt :In another cross-sectional study in which the effect of sunlight exposure on the level of 25(OH)D of individuals living in nursing home and in their own home were investigated, Okan et al., (2020) (4) found that 63.9% of the elderly people living in nursing home (40° north latitude) had vitamin D deficiency (< 20 ng/ml). In countries such as Spain (37° north latitude), Bulgaria (40°-42° north latitude) and Greece (37°- 38° north latitude) in the similar latitudes as Turkey and with plenty of sunshine, frequencies of vitamin D deficiency (< 20 ng/ml) in people living in nursing homes were 58.2, 65.2 and 96.0%, respectively (20-22). Relatively higher vitamin D deficiency in the present study could be due to low level of benefiting from sunlight and poor vitamin D content of the food provided by the nursing home.
Generalized vitamin D supplementation in nursing homes: Mission (im)possible?
2015, European Geriatric MedicineCitation Excerpt :Fig. 1 represents the supplementation ratios for each nursing home and at each measurement. We compared the baseline vitamin D supplementation ratio of the twelve first participating NH's [1–12], called “naive NH's”, with the five other NH's [13–17] that involved later in the study, called “knowing NH's” because of the gathered knowledge about the first results. The “knowing NH's” had a significant higher supplementation ratio than the “naive NH's” (64.7% ± 19.0 versus 26.0% ± 12.8; P < 0.001), visually represented by the black lines on Fig. 1.
Vitamin D and the Association with Cognitive Performance, Cognitive Decline, and Dementia
2015, Diet and Nutrition in Dementia and Cognitive DeclineVitamin D supplementation in older adults: Searching for specific guidelines in nursing homes
2013, Journal of Nutrition, Health and Aging
This study was supported by the Social Action Institute of Murcia, Murcia Region Government, Spain.