Supplementation with vitamin D and calcium in long-term care residents

Vitamin D deficiency is a common finding in institutionalized older persons. Vitamin D-deficient elderly persons are at higher risk of falls and fractures. Long-term care residents should be considered at high risk of vitamin D deficiency and therefore vitamin D supplementation is highly recommended in this population. The minimal effective dose is 800 IU per day. It is recommended that vitamin D supplementation should be implemented in all patients in residential aged care facilities. In addition to vitamin D, calcium supplementation has shown to enhance the effect of vitamin D on bone. Calcium intake should be optimized (1200-1500 mg per day recommended) and supplementation offered to those with inadequate intake. The addition of calcium depends on tolerance, history of kidney stones, and emerging data regarding its cardiovascular safety.     

The association of intakes of vitamin D and calcium with blood pressure among women

Blood pressure and its relationship to nutritional factors, particularly intakes of calcium and vitamin D, were evaluated among 86 women, aged 20-35 yr, and 222 women, aged 55-80 yr, who were not using diuretics. Observations were based on a study of bone density among women in two communities which included blood pressure determinations, a food frequency estimate of calcium intake, a 24-h dietary recall and an extensive supplement use history. There was no significant relationship between estimated current dietary calcium consumption and blood pressure in either age group. However, in younger women, there was a significant inverse relationship between estimated dietary intake of vitamin D and systolic blood pressure which remained significant (p = 0.0016) after adjusting for age, Quetelet index, alcohol consumption and calcium intake. Older women whose consumption of both vitamin D and calcium was less than the Recommended Dietary Allowance, 400 IU/day and 800 mg/day respectively, had a significantly higher systolic blood pressure (p = 0.0371) than their counterparts whose estimated intake met the RDA for at least one of the two nutrients. Vitamin D may be related to blood pressure through its regulation of calcium absorption from the gut or its interaction with parathyroid hormone in maintaining plasma calcium homeostasis.     

Food patterns,flour fortification,and intakes of calcium and vitamin D: a longitudinal study of Danish adults

STUDY OBJECTIVE: Deficiencies in calcium and vitamin D intakes are involved in the aetiology of osteoporosis, and health authorities recommend that the population consume a diet providing sufficient calcium and vitamin D. However, in 1987 the Danish Government withdrew a mandatory fortification of flour with calcium. This study examines intakes of calcium and vitamin D over time, in relation to food patterns, recommendations, and legislation. DESIGN: Food and nutrient intakes were measured by a short food frequency questionnaire (FFQ) and a thorough diet history interview, in 1987/88, and again six years later. SETTING: Copenhagen County, Denmark. PARTICIPANTS: 329 men and women, aged 35-65 years at first examination in 1987/88. RESULTS: At both examinations the non-enriched median intakes of calcium in men as well as women were above the recommended 600 mg/day. However, apparently the fortification of flour supplied up to 30% of the total calcium intake, and without the mandatory fortification, the percentage of adults with intakes below this recommendation increased from 6% to 22%. This group of subjects consumed cheese, milk, and oatmeal less often than those who had calcium intakes over 600 mg/day. During the study period the median intakes of vitamin D, which were well below the recommended 5 micrograms/day, did not change significantly. Associations between foods and vitamin D intakes were, in general, weak and insignificant, except for a positive association with fish intake. CONCLUSIONS: Data on calcium intakes suggest that the decision to stop the mandatory fortification of flour with calcium may have been premature. The short FFQ may be used for a rough classification of people in relation to their calcium intake, while this method seems insufficient for ranking vitamin D intakes.       

Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort

BACKGROUND: Dairy intake may increase prostate cancer risk, but whether this is due to calcium's suppression of circulating vitamin D remains unclear. Findings on calcium and vitamin D intake and prostate cancer are inconsistent. OBJECTIVE: We examined the association of dairy, calcium, and vitamin D intake with prostate cancer. DESIGN: In a prospective study of 3612 men followed from 1982-1984 to 1992 for the first National Health and Nutrition Examination Epidemiologic Follow-up Study, 131 prostate cancer cases were identified. Dietary intake was estimated from questionnaires completed in 1982-1984. Relative risk (RR) and 95% CIs were estimated by using Cox proportional hazards models adjusted for age, race, and other covariates. RESULTS: Compared with men in the lowest tertile for dairy food intake, men in the highest tertile had a relative risk (RR) of 2.2 (95% CI: 1.2, 3.9; trend P = 0.05). Low-fat milk was associated with increased risk (RR = 1.5; 95% CI: 1.1, 2.2; third compared with first tertile; trend P = 0.02), but whole milk was not (RR = 0.8; 95% CI: 0.5, 1.3; third compared with first tertile; trend P = 0.35). Dietary calcium was also strongly associated with increased risk (RR = 2.2; 95% CI: 1.4, 3.5; third compared with first tertile; trend P = 0.001). After adjustment for calcium intake, neither vitamin D nor phosphorus was clearly associated with risk. CONCLUSIONS: Dairy consumption may increase prostate cancer risk through a calcium-related pathway. Calcium and low-fat milk have been promoted to reduce risk of osteoporosis and colon cancer. Therefore, the mechanisms by which dairy and calcium might increase prostate cancer risk should be clarified and confirmed.     

Underutilization of calcium and vitamin D supplements in an academic long-term care facility

BACKGROUND: Good scientific evidence indicates that calcium and vitamin D supplementation decrease the incidence of osteoporosis-related fractures among institutionalized elderly. OBJECTIVE: The objective was to study the frequency of prescribing calcium and vitamin D supplements in elderly institutionalized individuals in a large community teaching nursing home. METHODS: A cross-sectional chart review study of 177 consecutively located elderly residents from an 899-bed academic long-term care facility. RESULTS: Calcium and vitamin D supplements were prescribed in only 12% and 9% of subjects, respectively. Among subjects with the diagnosis of osteoporosis (n = 12), 66% were prescribed calcium and 58% were prescribed vitamin D supplements. Among subjects with hip fractures (n = 8), only 25% were prescribed calcium with a similar percentage prescribed vitamin D supplements. Female residents were more likely than male residents to receive calcium (P <0.05) and vitamin D supplements (P = 0.08). CONCLUSION: There is a major need to increase the utilization of calcium and vitamin D supplementation among institutionalized elderly to decrease the risk of osteoporotic fractures, including hip fractures.     

A quality improvement study on calcium and vitamin D supplementation in long-term care

OBJECTIVES: The objectives of this study were to evaluate the impact of a quality improvement (QI) study on improving calcium and vitamin D supplementation in a long-term care setting. DESIGN: Retrospective chart review. SETTING: An academic long-term care facility that specializes in dementia care in St Louis, MO. PARTICIPANTS: Participants consisted of 83 long-term care residents. INTERVENTION: The quality improvement team created an educational letter that was signed by the medical director and sent to the facilities' primary care physicians. This letter provided clinicians with the rationale and method to achieve adequate calcium supplementation, assess vitamin D status, and provide adequate vitamin D supplementation in our long-term care setting. Following the letter, the facility pharmacist reviewed the orders during monthly medication reviews and faxed requests to the primary care physicians for appropriate supplements or laboratory tests when necessary. MEASUREMENTS: We reviewed the charts for the presence of calcium supplementation orders, vitamin D levels, and vitamin D supplementation before and after our QI intervention. RESULTS: Of the 83 resident charts that were reviewed, only 37 (44.6%) had calcium supplementation, 19 (22.8%) had assessment of their vitamin D status, and 29 (34.9%) had ongoing vitamin D supplementation prior to implementation of the study. After the QI intervention, calcium supplementation was present in 66 residents (79.5%), vitamin D status had been assessed in 61 residents (73.4%), and vitamin D supplementation had been initiated in 65 residents (78.3%). These changes were statistically significant (P < .05). CONCLUSION: A quality improvement project that used an educational letter from the medical director combined with a medication and laboratory review by the pharmacist was able to increase the number of residents in our long-term care setting with calcium supplementation, increase the number of residents who had vitamin D status assessed, identify many residents with low vitamin D levels, and increase supplementation of vitamin D when indicated.     

Higher amounts of body fat are associated with inadequate intakes of calcium and vitamin D in African American women

Calcium and vitamin D are associated with obesity. We hypothesized that African American women with higher calcium and vitamin D intakes would have lower body fat compared with women with lower calcium and vitamin D intakes. This cross-sectional study included 100 premenopausal African American women aged 18 to 40 years with a spectrum of body mass indices (17.3-46.7 kg/m²). Dietary information was obtained using 24-h recalls. Total body fat was determined by dual-energy x-ray absorptiometry and reported as percentage body fat (%BF). Subjects' data were divided into 2 groups (n = 50 per group) based on the median quartile of %BF, and differences were determined using independent t tests. Women with at least 37.9%BF had mean calcium (mg per day ± SD) and vitamin D intakes (µg per day ± SD) of 528.6 ± 146.0 and 3.8 ± .9, respectively. In comparison, women with lower %BF (<37.9%) had higher (P < .001) calcium and vitamin D intakes of 911.5 ± 208.3 and 5.0 ± 0.8, respectively. Partial correlation coefficients (controlling for the confounding variables of fat, carbohydrate, and protein intakes) indicated significant (P < 0.001) inverse associations between calcium intake and %BF (r = −.666), and vitamin D and %BF (r = −.460) in the 100 women. In conclusion, women with lower intakes of calcium and vitamin D were more likely to exhibit excessive adiposity compared with women with higher intakes.     

Drink consumption in British preschool children: relation to vitamin C, iron and calcium intakes

Objective To examine the impact of soft drinks, fruit juices, milk and tea consumption on vitamin C, iron and calcium intakes in a large, representative sample of preschool children in the UK.
Design Secondary analysis of 4-day weighed dietary diaries.
Sample 1675 children aged 1.5–4.5 years living in the UK in 1992/993.
Results Fruit juice consumers, but not soft drink consumers, had higher vitamin C intakes and higher plasma ascorbate levels than nonconsumers ( P  < 0.001). However, overall intakes tended to exceed the RNI and 45% of children still had adequate intakes without the contribution of soft drinks and 56% without the contribution of fruit juice. Children who did not consume fruit juice or soft drinks were no more likely to have depleted levels of vitamin C than consumers. Tea drinkers had diets which were lower in iron and vitamin C than nonconsumers ( P  < 0.005). They had lower levels of haemoglobin ( P  < 0.05) but not ferritin. Children under 4 years old were less likely to meet the RNI for iron if they were tea drinkers ( P  < 0.005) but no more likely to be anaemic. Calcium intakes were significantly higher for whole milk consumers than for nonconsumers ( P  < 0.005) and 73% of overall calcium intake was predicted by quantity of all milks consumed. Whole milk consumers both under and over 4 years of age were significantly more likely to reach the RNI for calcium ( P  < 0.00005 and P  < 0.05).
Conclusions Preschool children's drinking has an impact on their intakes of vitamin C, iron and calcium. In particular, intakes of calcium are closely linked to the amount of milk consumed in this age group.     

Suburban clustering of vitamin D deficiency in Melbourne, Australia

OBJECTIVE: A high prevalence of mild to moderate vitamin D deficiency has been observed in women who have recently arrived from the horn of Africa and living in inner Melbourne. Vitamin D status of women with differ-ing age and ethnic distributions residing in other suburbs is unknown. METHOD: A tertiary referral Women's hospital-based survey of serum 25(OH)D concentrations in 2,690 women aged 14-78 years residing in Mel-bourne between 1 July 2004 and 30 June 2005. We computed odds of serum 25(OH)D concentrations<50 nmol/L and used tests of homogeneity across different suburbs in Melbourne, Victoria. RESULTS: Women with moderate vitamin D deficiency from all suburbs were young [29.1+/-7.2 years (mean+/-standard deviation)]. The odds of moderate vitamin D deficiency were highest in inner suburbs and Greenvale, Coburg, Pascoe Vale South, Fawkner, Broadmeadows and Campbellfield from the Hume-Moreland municipality (p value for homogeneity of odds<0.001). CONCLUSION: Vitamin D deficiency ap-pears to be a growing health concern in Australia and may be more prevalent in younger women in Victoria than anticipated.     

Long-latency deficiency disease: insights from calcium and vitamin D

Nutrient intake recommendations and national nutritional policies have focused primarily on prevention of short-latency deficiency diseases. Most nutrient intake recommendations today are based on prevention of the index disease only. However, inadequate intakes of many nutrients are now recognized as contributing to several of the major chronic diseases that affect the populations of the industrialized nations. Often taking many years to manifest themselves, these disease outcomes should be thought of as long-latency deficiency diseases. Sometimes they come about by the same pathophysiologic mechanism that produces the index disease, but sometimes the mechanisms are completely different. Well-documented examples of both short- and long-latency deficiency states involving calcium and vitamin D are described briefly. Then, the insights derived from these nutrients are tentatively applied to folic acid. Discerning the full role of nutrition in long-latency, multifactorial disorders is probably the principal challenge facing nutritional science today. The first component of this challenge is to recognize that inadequate intakes of specific nutrients may produce more than one disease, may produce diseases by more than one mechanism, and may require several years for the consequent morbidity to be sufficiently evident to be clinically recognizable as "disease." Because the intakes required to prevent many of the long-latency disorders are higher than those required to prevent the respective index diseases, recommendations based solely on preventing the index diseases are no longer biologically defensible.     

The changing availability of residential aged care in Australia

Australian aged care services have undergone a series of substantial reforms in recent years under the rubric of the Aged Care Reform Strategy. Overall, there has been a progressive refinement of the targeting of available services on those most in need, defined in terms of both disability levels and financial resources. A key component of this process has been a deliberate reduction in the relative emphasis accorded to nursing home care within the aged care system. This has been accompanied by increases in the resources directed toward less intensive forms of residential care (hostels) and community based services. This paper explores the actual consequences of these intentional policy changes in terms of the availability of nursing home and hostel care, and the changing characteristics of nursing home residents. The results suggest that a more substantial reduction has occurred in the availability of nursing home care than has hitherto been suggested, with consequent decreases in the proportion of aged persons in nursing homes. The effect has been particularly marked amongst women and the very old. These findings raise policy questions about the appropriateness of current and planned future levels of provision.