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Association between vitamin D intake and bone mineral density in Koreans aged ≥ 50 years: analysis of the 2009 Korea National Health and Nutrition Examination Survey using a newly established vitamin D database

  • Yoo, Kyoung-Ok (Food and Nutrition Major, Woosong University) ;
  • Kim, Mi-Ja (Department of Food and Nutrition, Daejeon Institute of Science and Technology) ;
  • Ly, Sun Yung (Department of Food and Nutrition, Chungnam National University)
  • Received : 2018.06.15
  • Accepted : 2018.11.29
  • Published : 2019.04.01

Abstract

BACKGROUND/OBJECTIVES: Vitamin D plays an important role in skeletal growth and maintenance and in the prevention of various diseases. We investigated the relationship between vitamin D intake and bone mineral density (BMD) in Korean adults aged ${\geq}50$ years using the 2009 Korea National Health and Nutrition Examination Survey data. SUBJECTS/METHODS: This study was conducted in 1,808 subjects aged ${\geq}50$ years with BMD data in Korea. Dietary vitamin D levels were assessed by the 24-hour recall method. BMD was measured using dual-energy X-ray absorptiometry. We investigated general characteristics and the association between these characteristics, vitamin D status, and BMD. RESULTS: Vitamin D intake was significantly lower in the osteoporosis group among women (P < 0.05). Among all subjects, the higher the serum 25(OH)D concentration, the higher the whole-body total BMD (WBT-BMD), femoral total hip BMD, and femoral neck BMD (P < 0.01). In the serum vitamin D-deficient group of both the total population and women, serum 25(OH)D concentration was associated with WBT-BMD (P < 0.05). Among women with a calcium intake < 537.74 mg/day, BMD of those with a vitamin D intake > $2.51{\mu}g/day$ (average intake of women) was higher than that of women with a vitamin D intake ${\leq}2.51{\mu}g/day$ (P < 0.001). CONCLUSIONS: Korean adults should increase their BMD by increasing serum 25(OH)D concentration. Furthermore, increasing vitamin D intake could improve BMD, especially in Korean women who consume less calcium than the estimated average requirement.

Keywords

References

  1. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10. https://doi.org/10.1016/0002-9343(91)90512-V
  2. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994;843:1-129.
  3. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop 2011;45:15-22. https://doi.org/10.4103/0019-5413.73656
  4. Oden A, McCloskey EV, Kanis JA, Harvey NC, Johansson H. Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int 2015;26:2243-8. https://doi.org/10.1007/s00198-015-3154-6
  5. Cauley JA. Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol 2017;29:150-6. https://doi.org/10.1097/BOR.0000000000000365
  6. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Korea Centers for Disease Control and Prevention; 2009.
  7. Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O'Malley CD. Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos 2014;9:182. https://doi.org/10.1007/s11657-014-0182-3
  8. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int 2016;27:367-76. https://doi.org/10.1007/s00198-015-3386-5
  9. DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 2004;80:1689S-1696S. https://doi.org/10.1093/ajcn/80.6.1689S
  10. Holick MF. The influence of vitamin D on bone health across the life cycle. J Nutr 2005;135:2726S-2727S. https://doi.org/10.1093/jn/135.11.2726S
  11. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academies Press; 2011.
  12. Yoo K, Cho J, Ly S. Vitamin D intake and serum 25-Hydroxyvitamin D levels in Korean adults: analysis of the 2009 Korea national health and nutrition examination survey (KNHANES IV-3) Using a newly established vitamin D database. Nutrients 2016;8:610. https://doi.org/10.3390/nu8100610
  13. Armas LA, Dowell S, Akhter M, Duthuluru S, Huerter C, Hollis BW, Lund R, Heaney RP. Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color. J Am Acad Dermatol 2007;57:588-93. https://doi.org/10.1016/j.jaad.2007.03.004
  14. Holick MF. Sunlight "D"ilemma: risk of skin cancer or bone disease and muscle weakness. Lancet 2001;357:4-6. https://doi.org/10.1016/S0140-6736(00)03560-1
  15. Kim M, Yoon C. The research on the ultraviolet protector recognition of the adult and propensity to consume. J Beauty Ind 2014;8:63-84.
  16. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008;87:1080S-6S. https://doi.org/10.1093/ajcn/87.4.1080S
  17. van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 2011;25:671-80. https://doi.org/10.1016/j.beem.2011.06.007
  18. Nanri A, Foo LH, Nakamura K, Hori A, Poudel-Tandukar K, Matsushita Y, Mizoue T. Serum 25-hydroxyvitamin d concentrations and seasonspecific correlates in Japanese adults. J Epidemiol 2011;21:346-53. https://doi.org/10.2188/jea.JE20100161
  19. Sadat-Ali M, Al Elq AH, Al-Turki HA, Al-Mulhim FA, Al-Ali AK. Influence of vitamin D levels on bone mineral density and osteoporosis. Ann Saudi Med 2011;31:602-8. https://doi.org/10.4103/0256-4947.87097
  20. Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD. Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc 2003;51:1533-8. https://doi.org/10.1046/j.1532-5415.2003.51510.x
  21. Khazai N, Judd SE, Tangpricha V. Calcium and vitamin D: skeletal and extraskeletal health. Curr Rheumatol Rep 2008;10:110-7. https://doi.org/10.1007/s11926-008-0020-y
  22. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003;326:469. https://doi.org/10.1136/bmj.326.7387.469
  23. Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007:1-235.
  24. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int 2005;16:713-6. https://doi.org/10.1007/s00198-005-1867-7
  25. Kim SH, Han JH, Kim WY. Health functional food use and related variables among the middle-aged in Korea. Korean J Nutr 2010;43:294-303. https://doi.org/10.4163/kjn.2010.43.3.294
  26. Rho HK, Park MM. Perception level of vitamin D and calcium on osteoporosis treatment. J Korean Soc Menopause 2008;14:115-29.
  27. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA Jr, Malik R, Arnsten JH. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med 2008;121:406-18. https://doi.org/10.1016/j.amjmed.2007.12.012
  28. Gaddini GW, Turner RT, Grant KA, Iwaniec UT. Alcohol: a simple nutrient with complex actions on bone in the adult skeleton. Alcohol Clin Exp Res 2016;40:657-71. https://doi.org/10.1111/acer.13000
  29. DeSimone DP, Stevens J, Edwards J, Shary J, Gordon L, Bell NH. Influence of body habitus and race on bone mineral density of the midradius, hip, and spine in aging women. J Bone Miner Res 1989;4:827-30. https://doi.org/10.1002/jbmr.5650040606
  30. Yoo JI, Ha YC, Kwon HB, Lee YK, Koo KH, Yoo MJ. High Prevalence of sarcopenia in Korean patients after hip fracture: a case-control study. J Korean Med Sci 2016;31:1479-84. https://doi.org/10.3346/jkms.2016.31.9.1479
  31. Ogata N, Chikazu D, Kubota N, Terauchi Y, Tobe K, Azuma Y, Ohta T, Kadowaki T, Nakamura K, Kawaguchi H. Insulin receptor substrate-1 in osteoblast is indispensable for maintaining bone turnover. J Clin Invest 2000;105:935-43. https://doi.org/10.1172/JCI9017
  32. Krakauer JC, McKenna MJ, Rao DS, Whitehouse FW. Bone mineral density in diabetes. Diabetes Care 1997;20:1339-40.
  33. Piepkorn B, Kann P, Forst T, Andreas J, Pfutzner A, Beyer J. Bone mineral density and bone metabolism in diabetes mellitus. Horm Metab Res 1997;29:584-91. https://doi.org/10.1055/s-2007-979106
  34. Srikanthan P, Crandall CJ, Miller-Martinez D, Seeman TE, Greendale GA, Binkley N, Karlamangla AS. Insulin resistance and bone strength: findings from the study of midlife in the United States. J Bone Miner Res 2014;29:796-803. https://doi.org/10.1002/jbmr.2083
  35. Laktasic-Zerjavic N, Korsic M, Crncevic-Orlic Z, Kovac Z, Polasek O, Soldo-Juresa D. Vitamin D status, dependence on age, and seasonal variations in the concentration of vitamin D in Croatian postmenopausal women initially screened for osteoporosis. Clin Rheumatol 2010;29:861-7. https://doi.org/10.1007/s10067-010-1409-3
  36. Gao C, Qiao J, Li SS, Yu WJ, He JW, Fu WZ, Zhang ZL. The levels of bone turnover markers 25(OH)D and PTH and their relationship with bone mineral density in postmenopausal women in a suburban district in China. Osteoporos Int 2017;28:211-8. https://doi.org/10.1007/s00198-016-3692-6
  37. Henry HL, Bouillon R, Norman AW, Gallagher JC, Lips P, Heaney RP, Vieth R, Pettifor JM, Dawson-Hughes B, Lamberg-Allardt CJ, Ebeling PR. 14th Vitamin D Workshop consensus on vitamin D nutritional guidelines. J Steroid Biochem Mol Biol 2010;121:4-6. https://doi.org/10.1016/j.jsbmb.2010.05.008
  38. Hwang YC, Ahn HY, Jeong IK, Ahn KJ, Chung HY. Optimal serum concentration of 25-hydroxyvitamin D for bone health in older Korean adults. Calcif Tissue Int 2013;92:68-74. https://doi.org/10.1007/s00223-012-9669-3
  39. Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 1991;115:505-12. https://doi.org/10.7326/0003-4819-115-7-505
  40. Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 2004;19:370-8. https://doi.org/10.1359/JBMR.0301240
  41. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O'Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D; Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006;354:669-83. https://doi.org/10.1056/NEJMoa055218
  42. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992;327:1637-42. https://doi.org/10.1056/NEJM199212033272305
  43. Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ. 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 2002;13:257-64. https://doi.org/10.1007/s001980200023
  44. Black LJ, Seamans KM, Cashman KD, Kiely M. An updated systematic review and meta-analysis of the efficacy of vitamin D food fortification. J Nutr 2012;142:1102-8. https://doi.org/10.3945/jn.112.158014
  45. Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R, Spiegelman D, Dietrich T, Willett WC. Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 2009;24:935-42. https://doi.org/10.1359/jbmr.081242
  46. Lee SW, Lee SH, Kweon YR, Lee HJ. Factors relating to bone mineral density of adult man in Korea. J Korean Acad Fam Med 2003;24:158-65.
  47. National Institute for Health and Care Excellence. Vitamin D: supplement use in specific population groups. Public health guideline [Internet]. London: National Institute for Health and Care Excellence; 2014 [cited 2014 November 26]. Available from: https://www.nice.org.uk/guidance/ph56.
  48. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, D.C.: National Osteoporosis Foundation; 2008.

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