Prevalence of vitamin K and vitamin D deficiency in patients with hepatobiliary and pancreatic disorders

Little is known about the role of fat-soluble vitamins K and D in liver function and bone metabolism in biliary and pancreatic diseases associated with cholestasis and/or fat malabsorption. The aim of this study was to determine vitamin K of bone, vitamin D and parathyroid hormone status in patients with biliary and pancreatic disorders. In 90 consecutive patients (mean ± SD age, 65.5 ± 17.7 years; 45 females) undergoing endoscopic retrograde cholangiopancreatography (68 with choledocholithiasis, 14 with other benign condition, and 8 with cholangiopancreatic cancers) fasting concentrations of carboxylated (cOC) and undercarboxylated osteocalcin (ucOC), 25-hydroxyvitamin D, calcium, phosphorus, magnesium, prothrombin time, liver function tests, lipase, and creatinine were measured. Vitamin D deficiency (25-hydroxyvitamin D <50 nmol/L) was found in 45.6% of patients and elevated parathyroid hormone levels in 27.8%. The ratio ucOC/cOC (index of vitamin K deficiency) was above 20% in 50.6% of patients, above 30% in 31%, and above 50% in 18.4%. Hyperbilirubinemia was a significant independent predictor of low cOC (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.9-59.4; P = .07). The ratio ucOC/cOC positively correlated with alanine aminotransferase levels (r = 0.410; P < .001). Elevated γ-glutamyltransferase (>180 U/L) and international normalized ratio (>1.1) levels were significant independent predictors of ucOC/cOC greater than 30% after adjustment for other covariants (OR, 5.5; 95% CI, 1.2-25.2; P = .027, and OR, 3.1; 95% CI, 1.1-8.8; P = .036, respectively). This study demonstrates that vitamin K and vitamin D deficiencies are common in patients undergoing endoscopic retrograde cholangiopancreatography. Liver dysfunction is associated with and predictive of vitamin K deficiency of bone and decreased production of osteocalcin, indicating the need for appropriate supplementation.     

老年人血浆维生素K和D水平的季节变化

目的了解老年人群血浆维生素K和维生素D水平的季节变化。方法对85名健康老年人用放射免疫分析法测定春秋两季血浆维生素D(25(OH)D)和甲状旁腺素(PTH)含量,用高压液相色谱法测定血浆维生素K含量。结果血浆维生素K水平女性在春秋两季均明显高于男性,而男性和女性各自无季节性差异。无论男女秋季血浆维生素(25(OH)D)水平明显高于春季,同一季节内男女间差异无统计学意义。维生素D缺乏率女性春季为63.4%,秋季为7.3%。男性春季为65.9%,秋季无缺乏者。春季维生素D缺乏率显著高于秋季(P<0.05)。男女秋季血浆PTH浓度明显低于春季。老年女性春季血浆25(OH)D浓度和血浆PTH浓度之间呈负相关(r=-0.426,P<0.001)。结论该人群血浆25(OH)D和PTH有明显的季节变化,春季血浆25(OH)D水平低。而血浆维生素K没有季节变化。     

北京市城区中老年人髋部骨折的病例对照研究

目的 探索北京市中老年人髋部骨髂发生的危险因素,为今后开展髋部骨折的病因学研究提供线索。方法对北京市城区２０１例５０岁以上髋部骨折病例和４０２名对照进行了１：２配比的病例对照研究。结果 与髋部骨折危险性增另有关的危险因素有低钙饮食、３０年前不上立活动、未服用钙剂、体质指数低目前不经常体育锻炼、未曾在农村居住、工作性质为脑力劳动、髋部骨折阳性家族史和糖尿病。对于女性,绝经提前和哺乳时间和时间短也是髋     

Association of vitamin K deficiency with bone metabolism and clinical disease activity in inflammatory bowel disease

Objective

Inflammatory bowel disease (IBD) is a chronic inflammatory process in the digestive tract and patients with IBD develop osteopenia. Although vitamins K and D are important for maintaining bone health and inhibiting inflammation, their roles in patients with IBD are not clear. We investigated the roles of vitamins K and D in the bone health and inflammation in patients with IBD.

Methods

Bone mineral density (BMD) of patients with IBD (Crohn’s disease [CD], n = 47, and ulcerative colitis [UC], n = 40) was measured with dual-energy X-ray absorptiometry. Vitamin K and D levels of patients with IBD and healthy volunteers (n = 41) were evaluated by measuring serum undercarboxylated osteocalcin and 1,25 dihydroxyvitamin D, respectively. Clinical activity index was evaluated in patients with CD and UC.

Results

BMD was low in patients with CD and UC. Serum undercarboxylated osteocalcin levels were significantly higher in patients with CD, but not with UC, compared with healthy subjects, indicating that bone vitamin K is insufficient in patients with CD. The levels of undercarboxylated osteocalcin were significantly correlated with the clinical activity index of CD, although they were not correlated with BMD. The levels of 1,25 dihydroxyvitamin D were significantly lower in patients with CD and UC than in healthy subjects. The levels of 1,25 dihydroxyvitamin D were inversely correlated with BMD in patients with UC and were not correlated with the clinical activity index of CD.

Conclusion

Vitamins K and D are insufficient in patients with IBD. Insufficiency of vitamin K is suggested to be associated with inflammatory processes of CD.     

In-hospital case-fatality of aged patients with hip fracture in Catalonia, Spain

Hip fracture case-fatality in patients aged 65 years or older was studied in patients admitted to acute care hospitals in Catalonia over a 1-year period. 1222 femoral neck fractures and 1648 pertrochanteric fractures were identified. Women (76.9%) were most frequently and significantly older than men. Average age in pertrochanteric fracture was significantly higher than cervical fracture. The overall in-hospital case-fatality rate was 6.8%. Male gender, advanced age, pertrochanteric fracture and conservative management were associated with a significantly higher case-fatality rate. Multivariate logistic regression analyses demonstrated that previously seen associations showed univariate analysis. However, because interaction was observed, association within fracture and case-fatality was studied separately by gender. Men with pertrochanteric fracture showed the greatest association for in-hospital case-fatality (OR, 3.3; 95% CI: 2–5.5) compared with women with femoral neck fractures. In models with in-hospital case-fatality or no autonomy at discharge or in-hospital case-fatality or no autonomy at discharge or readmission as dependent variables, the odds ratio of death for conservative management of hip fracture were 3.7 (95% CI: 2.3–6) and 3.1 (95% CI: 1.9–4.9), respectively. This information should be taken into consideration for further analyses for long-term outcome and resource consumption by patients with hip fracture.     

骨质疏松性髋部骨折的直接经济负担及其影响因素分析

目的分析骨质疏松性髋部骨折患者的直接经济负担及其影响因素。方法对北京协和医院1998年1月至2002年12月骨质疏松性髋部骨折出院患者采用回顾性问卷调查方式进行直接经济负担数据采集,并对影响因素进行单因素方差分析及多因素logistic回归分析。结果平均每例髋部骨折患者直接经济负担为32776元／年,影响直接经济负担总费用的因素有住院时间、结局、患者工作状态;住院期间费用影响因素有住院时间、患者骨折类型及患者工作状态;影响患者康复期费用的因素有患者住院及康复时间、结局。年龄、治疗方式及医疗负担方式对费用无显著性影响。结论骨质疏松性髋部骨折直接经济负担重,强调从经济学角度论证重视骨质疏松防治的重要性。     

老年髋部骨折患者术后感染的预防与控制

目的 探索老年髋部骨折患者术后感染的预防和控制措施,以预防与控制其术后感染,提高治愈率.方法 对医院2008年1月-2010年12月手术治疗的223例＞65岁髋部骨折患者进行回顾性调查分析.结果 223例髋部骨折患者中,167例合并有≥1种其他科疾病,以心血管疾病、糖尿病和呼吸系统疾病为主;入院后平均手术时间(4.29±2.45)d;手术方式为内固定或髋关节置换;术后感染共6例占2.7％,其中手术部位感染2例占0.9％,呼吸道感染1例占0.45％,尿路感染3例占1.35％.结论 对老年髋部骨折患者术后感染的预防和控制,除预防性应用抗菌药物外,应尽早请相关科室会诊,共同评估患者病情及制定围手术期治疗方案,重视围手术期镇痛和早期功能锻炼、离床活动.     

学龄儿童维生素D营养状况与身体肌肉量关系的研究

目的探讨学龄儿童维生素D营养状况与身体肌肉量的关系。方法研究对象来自“儿童青少年心血管与骨健康促进项目”,于2017年采用分层整群抽样的方法在北京市对15391名6~16岁儿童开展基线调查,2019年对其进行随访调查。进行问卷调查和检测血清25(OH)D,使用生物电阻抗法测定机体肌肉量,并计算全身肌肉质量指数(MMI)。采用多因素线性回归分析维生素D营养状况与基线和随访期MMI的关系。结果纳入分析的10890名儿童的年龄为(11.5±3.3)岁,男童占49.6%,基线25(OH)D水平为(35.4±12.0)nmol/L,充足率为11.1%。多因素线性回归校正年龄、性别、体脂肪量、吸烟、饮酒、奶制品摄入、维生素D补充、钙剂补充、体力活动、青春期发育状态后,未观察到维生素D营养状况与基线MMI水平关联有统计学意义(P>0.05)。而对于随访时点MMI,25(OH)D每增加10 nmol/L,其Z值增加0.008(P=0.058);相比于维生素D缺乏,维生素D不足和充足的儿童分别增高0.002(P=0.815)和0.037(P=0.031),趋势P=0.089。亚组分析显示,在BMI正常组中,25(OH)D每增加10 nmol/L,维生素D充足的儿童基线MMI和随访时点MMI Z值分别增高0.019和0.014,均P<0.05。结论儿童维生素D营养状况与身体肌肉量有关,维生素D充足的儿童倾向于在未来获得更高的肌肉量。倡导儿童青少年维持充足的维生素D水平,加强营养与运动,提升身体素质。     

孕晚期妇女服用钙及维生素D初步观察

目的观察孕晚期妇女服用钙及维生素D对孕期妇女低钙和维生素D缺乏的效果.方法对24例孕28周后的晚期妊娠妇女,每日服用碳酸钙加维生素D1片.并与同期11例不服任何钙剂及维生素D3的晚期妊娠妇女(对照组)进行比较.结果(1)用药组产前血清钙(Ca)、磷(P)、骨钙素(BGP)及25羟基D3(25OHD3)明显高于用药前的孕28周(P＜0.001);而对照组产前与孕28周比较无明显变化.(2)给药组产前尿羟脯氨酸与肌酐比值(HOP/cr)、尿钙(Ca)与肌酐比值(Ca/cr)比孕28周明显减少.(3)尿中Ⅰ型胶原交联C末端肽与肌酐比值(crosslaps/cr)给药组,和对照组在产前明显高于孕28周(P＜0.001),但产后42天,给药组明显低于对照组(P＜0.001).(4)两组血清碱性磷酸酶(AKP)产前明显均高于孕28周时水平(P＜0.001),表明胎盘产生大量AKP.结论孕期服用碳酸钙加维生素D3有明显促进骨形成,抑制骨吸收的作用和提高血清钙、磷的作用.给药8～10周后,虽然25OHD3比治疗前有明显升高,但仍低于同年龄健康妇女的水平,提示对孕产妇应适当增加维生素D3的用量.     

Effect of calcium fortified milk supplementation with or without vitamin K on biochemical markers of bone turnover in premenopausal women

OBJECTIVE: We compared the effect of supplementation with a fortified skimmed milk product (high calcium skim milk) with or without added phylloquinone (vitamin K(1)) on markers of bone formation and resorption in premenopausal women. METHODS: Eighty-two women 20 to 35 y of age were randomly allocated to three groups. Two groups received two daily servings of high calcium skim milk (1000 mg/d of extra calcium) with or without added phylloquinone (80 microg/d) for 16 wk, and a third control group received no supplementation. Bone density was assessed at baseline and the bone markers, total osteocalcin, type I N-terminal procollagen peptide, and cross-linked C-telopeptide of type I collagen were measured at baseline and at weeks 2, 12, and 16. Serum phylloquinone and undercarboxylated osteocalcin were measured in the control and vitamin K-supplemented groups at weeks 0 and 16. RESULTS: Baseline values for age, body mass index, and bone density did not differ across groups. In vitamin K-supplemented women, mean serum phylloquinone concentrations increased from 0.27 to 0.76 microg/L (P < 0.05) and undercarboxylated osteocalcin concentrations decreased from 9.68 to 4.46 microg/L (P < 0.05) over 16 wk. Plasma cross-linked C-telopeptide of type I collagen, total osteocalcin, and type I N-terminal procollagen peptide levels decreased significantly in both supplemented groups compared with the control group over 16 wk (cross-linked C-telopeptide of type I collagen >30%, total osteocalcin and type I N-terminal procollagen peptide >15%). CONCLUSION: Fortified milk supplementation in premenopausal women reduced bone turnover significantly. Phylloquinone fortification substantially improved vitamin K status but had no demonstrable additive effect on bone turnover in this short-term study.     

A food frequency questionnaire for the assessment of calcium, vitamin D and vitamin K: a pilot validation study

The study objective was to validate a food frequency questionnaire (FFQ) to assess calcium, vitamin D and vitamin K intakes in overweight and obese postmenopausal community-dwelling women. The FFQ was validated against intakes derived from a 5-day diet record (5DDR) that also included assessment of supplement intake. Strong correlations between methods were observed for all nutrients (r = 0.63, 0.89, 0.54 for calcium, vitamin D and vitamin K, respectively) and cross-classification analyses demonstrated no major misclassification of participants into intake quartiles. Bland-Altman analysis showed that the FFQ overestimated intakes for calcium, by 576 mg/day (95% CI, -668 to 1,821 mg/day), for vitamin D by 75 IU/day (95% CI, -359 to 510 IU/day), and for vitamin K by 167 mcg/day (95% CI, -233 to 568 mcg/day). This pilot study showed promising validation evidence for the use of this FFQ, which focuses on calcium, vitamin D and vitamin K intakes in postmenopausal women, as a screening tool in clinical and research settings.     

Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment

Throughout the life cycle the skeleton requires optimum development and maintenance of its integrity to prevent fracture. Bones break because the loads placed on them exceed the ability of the bone to absorb the energy involved. It is now estimated that one in three women and one in twelve men aged >55 years will suffer from osteoporosis in their lifetime and at a cost in the UK of > 1.7 pounds x 10(9) per year. The pathogenesis of osteoporosis is multifactorial. Both the development of peak bone mass and the rate of bone loss are determined by key endogenous and exogenous factors. Ca supplements appear to be effective in reducing bone loss in women late post menopause (>5 years post menopause), particularly in those with low habitual Ca intake (<400 mg/d). In women early post menopause (<5 years post menopause) who are not vitamin D deficient, Ca supplementation has little effect on bone mineral density. However, supplementation with vitamin D and Ca has been shown to reduce fracture rates in the institutionalised elderly, but there remains controversy as to whether supplementation is effective in reducing fracture in free-living populations. Re-defining vitamin D requirements in the UK is needed since there is evidence of extensive hypovitaminosis D in the UK. Low vitamin D status is associated with an increased risk of falling and a variety of other health outcomes and is an area that requires urgent attention. The role of other micronutrients on bone remains to be fully defined, although there are promising data in the literature for a clear link between vitamin K nutrition and skeletal integrity, including fracture reduction.     

Relationship between vitamin K status, bone mineral density, and hs-CRP in young Korean women

Vitamin K intake has been reported as an essential factor for bone formation. The current study was conducted under the hypothesis that insufficient vitamin K intake would affect inflammatory markers and bone mineral density in young adult women. The study was a cross-sectional design that included 75 women in their 20s. Physical assessments, bone mineral density measurements, 24-hr dietary recalls, and biochemical assessments for high sensitivity C-reactive protein (hs-CRP) and percentages of undercarboxylated osteocalcin (%ucOC) were performed. An analysis of vitamin K nutritional status was performed comparing first, second, and third tertiles of intake based on %ucOC in plasma. Vitamin K intake levels in the first, second, and third tertiles were 94.88 ± 51.48 µg, 73.85 ± 45.15 µg, and 62.58 ± 39.92 µg, respectively (P < 0.05). The T-scores of the first and third tertiles were 1.06 and -0.03, respectively, indicating that bone mineral density was significantly lower in the group with lower vitamin K intake (P < 0.05). There was a tendency for different serum hs-CRP concentrations between the first (0.04 ± 0.02) and third tertiles (0.11 ± 0.18), however this was not statistically significant. Regression analysis was performed to identify the correlations between vitamin K nutritional status, inflammatory markers, and bone mineral density after adjusting for age and BMI. Serum hs-CRP concentrations were positively correlated with vitamin K deficiency status (P < 0.05). And bone mineral density, which was represented by speed, was negatively correlated with vitamin K deficiency status (P < 0.05). In conclusion, status of vitamin K affects inflammatory status and bone formation. Therefore, sufficient intake of vitamin K is required to secure peak bone mass in young adult women.     

Importance of dietary advice,nutritional supplements and compliance for maintaining body weight and body fat after hip fracture

Objective  Poor nutritional status amongst elderly individuals with hip fractures is well documented. Studies have suggested that 30–50 % of patients admitted to orthopaedic departments suffer from protein-energy malnutrition (PEM). Design  An 6 month intervention study. Setting  The study was conducted in Sweden between February 2005 and October 2006. Participants  Elderly patients with hip fractures (n=32). Methods  Evaluation of compliance with individual nutritional support and whether body weight and body fat (BF) could be maintained after six months. Evaluation of possible effects of nutritional supplements and dietary advice after hip fracture on BMI, BF, and Mini Nutritional Assessment (MNA). Results  Overall compliance with supplement intake was 73%. After six months, BMI was unchanged. Women’s BF had decreased (P<0.01), although the mean calorie intake with nutritional support was 34 calories per kg body weight/day. Three groups could be identified: one group with increased body weight and BF, one with loss of body weight and BF, and one with increased body weight together with increased TBW and loss of BF. Participants who consumed 0–1 supplements daily lost more weight than those who consumed 2 supplements daily. There was a positive difference (p=<0.001) for women between MNA values at baseline and after six months. Conclusion  In the present study compliance was satisfactory at the group level, and the energy and protein intake increased significantly. BMI was unchanged during the 6 months period. However, the women lost BF during the study period of with some had increasing total body water (TBW). MNA values for women changed in a positive direction.     

学龄儿童维生素D营养状况与跟骨骨密度关系的前瞻性队列研究

目的探讨学龄儿童维生素D营养状况与跟骨骨密度的关系。方法研究对象来自“儿童青少年心血管与骨健康促进项目”,于2017年采用分层整群抽样的方法在北京市对15391名6~16岁儿童开展基线调查,2019年对其进行随访调查。进行问卷调查,测量血清25(OH)D和跟骨超声骨密度(BMD)。采用多因素线性回归和logistic回归分析基线维生素D营养状况与随访期跟骨BMD及其变化的关系。结果纳入分析的10914名儿童的年龄为(11.5±3.3)岁,男童占49.6%,基线25(OH)D水平为(35.4±12.0)nmol/L,缺乏率为36.1%。多因素回归分析显示,校正年龄、性别、BMI、吸烟、饮酒、奶制品摄入、维生素D补充、钙剂补充、体力活动、青春期发育状态和基线跟骨BMD Z值后,25(OH)D每增加10 nmol/L,随访时点跟骨BMD Z值增加0.01(P=0.041),2年间发生跟骨BMD Z值下降的OR=0.96(95%CI:0.93~1.00),P=0.030;相对于维生素D充足,维生素D不足和缺乏的儿童随访时点跟骨BMD Z值下降0.03(P=0.307)和0.06(P=0.046),2年间跟骨BMD Z值下降的风险分别增加15%(P=0.037)和21%(P=0.006),趋势P值均<0.05。结论维生素D营养状况与跟骨BMD密切相关,维生素D充足的儿童倾向于获得更高的BMD水平。倡导儿童青少年维持充足的维生素D水平,加强营养与运动,促进骨骼健康。