Marginal nutritional status among institutionalized elderly women as compared to those living more independently (Dutch Nutrition Surveillance System).

The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5′-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5′-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5′-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.     

Nutrition and aging: nutritional status of "apparently healthy" elderly (Dutch nutrition surveillance system)

In a nationwide survey the nutritional status was assessed of 539 apparently healthy, independently living elderly aged 65-79 years. Anthropometric data showed no energy deficits. The prevalence of anemia was 4 and 1% among men and women, respectively. Many elderly showed a low level of 25-hydroxyvitamin D in plasma (less than 31 nmol/L: men 35%; women 43%), indicating a marginal status. Although the prevalence of low blood levels of folate, pyridoxal-5'-phosphate, and total carotenoids was higher among the elderly than among younger adults, clear (clinical) signs of nutritional deficiencies were not observed. Prevalence of obesity (13%), hypercholesterolemia (38%), and hypertension (63%) was found to be high, the percentages being higher for women than for men. Several indicators of the nutritional status appeared to differ among age groups. It is concluded that few differences can be considered as being due to physiological aging, which finding should be reflected in reference values for elderly people.     

Multiple micronutrient deficiencies persist during early childhood in Mongolia

Data on the prevalence of micronutrient deficiencies in children in Mongolia is limited. We therefore determined the prevalence of anaemia, iron deficiency anaemia (IDA), and deficiencies of iron, folate, vitamin A, zinc, selenium, and vitamin D among young Mongolian children. Anthropometry and non-fasting morning blood samples were collected from 243 children aged 6-36 months from 4 districts in Ulaanbaatar and 4 rural capitols for haemoglobin (Hb), serum ferritin, folate, retinol, zinc, selenium, and 25-hydroxyvitamin D (25-OHD) assays. Children with alpha-1-glycoprotein >1.2mg/L (n=27) indicative of chronic infection were excluded, except for folate, selenium, and 25-hydroxyvitamin D assays. Of the children 14.5% were stunted and none were wasted. Zn deficiency (serum Zn <9.9 micromol/L) had the highest prevalence (74%), followed by vitamin D deficiency 61% (serum 25-OHD<25 nmol/L). The prevalence of anaemia (24%) and iron deficiency anaemia (IDA) (16%) was lower, with the oldest children (24-36 mos) at lowest risk. Twenty one percent of the children had low iron stores, and 33% had vitamin A deficiencies (serum retinol < 0.70 micromol/L), even though two thirds had received vitamin A supplements. Serum selenium values were low, perhaps associated with low soil selenium concentrations. In contrast, no children in Ulaanbaatar and only 4% in the provincial capitols had low serum folate values (<6.8 nmol/L). Regional differences (p<0.05) existed for anaemia, deficiencies of vitamin A, folate, and selenium, but not for zinc or IDA. Of the children, 78% were at risk of > or = two coexisting micronutrient deficiencies emphasizing the need for multimicronutrient interventions in Mongolia.     

Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur

OBJECTIVE: To describe the vitamin D status of women living in two Asian cities,--Jakarta (6 degrees S) and Kuala-Lumpur (2 degrees N), to examine the association between plasma 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations, and to determine a threshold for plasma 25-hydroxyvitamin D above which there is no further suppression of PTH. Also, to determine whether dietary calcium intake influences the relationship between PTH and 25-hydroxyvitamin D. DESIGN: Cross-sectional. SETTING: Jakarta, Indonesia and Kuala Lumpur, Malaysia. PARTICIPANTS: A convenience sample of 504 non-pregnant women 18-40 years. MAIN MEASURES: Plasma 25-hydroxyvitamin D and PTH. RESULTS: The mean 25-hydroxyvitamin D concentration was 48 nmol/l. Less than 1% of women had a 25-hydroxyvitamin D concentration indicative of vitamin D deficiency (<17.5 nmol/l); whereas, over 60% of women had a 25-hydroxyvitamin D concentration indicative of insufficiency (<50 nmol/l). We estimate that 52 nmol/l was the threshold concentration for plasma 25-hydroxyvitamin D above which no further suppression of PTH occurred. Below and above this concentration the slopes of the regression lines were -0.18 (different from 0; P=0.003) and -0.01 (P=0.775), respectively. The relation between vitamin D status and parathyroid hormone concentration did not differ between women with low, medium or high calcium intakes (P=0.611); however, even in the highest tertile of calcium intake, mean calcium intake was only 657 mg/d. CONCLUSION: On the basis of maximal suppression of PTH we estimate an optimal 25-hydroxyvitamin D concentration of approximately 50 nmol/l. Many women had a 25-hydroxyvitamin D below this concentration and may benefit from improved vitamin D status.     

Very high rates of vitamin D insufficiency in women of child-bearing age living in Beijing and Hong Kong

We aimed to describe the vitamin D status of young women living in two Chinese cities in the spring--Beijing in the north (latitude 39 degrees north) and Hong Kong (latitude 22 degrees north) in the south. We also examined the relationship between serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations to determine a threshold for serum 25-hydroxyvitamin D above which there is no further suppression of PTH. Finally, we examined whether dietary Ca intake influences this relationship. Non-pregnant women aged 18-40 years (n 441) were recruited between February and June. Fasting blood was collected and dietary intakes were assessed using 5 d food records. Mean serum 25-hydroxyvitamin D concentration was lower in Beijing than Hong Kong women (29 v. 34 nmol/l; P < 0.001). Vitamin D deficiency (< or = 25 nmol/l) was indicated in 40% of Beijing and 18% of Hong Kong women, and over 90% of women in both cities were insufficient (< or = 50 nmol/l). Mean Ca and vitamin D intakes were 478 mg/d and 2.0 microg/d, respectively. The relationship between 25-hydroxyvitamin D concentration and PTH was linear throughout the range with a slope of -0.36 (different from 0; P < 0.001; R 0.26), with no apparent threshold. There was no influence of Ca intake on the relationship between 25-hydroxyvitamin D and PTH concentration. Vitamin D deficiency is common and insufficiency is very common in non-pregnant women in Hong Kong and Beijing during spring. Serum 25-hydroxyvitamin D was inversely associated with PTH with no apparent threshold. Strategies such as vitamin D fortification or supplementation may be required.     

Longitudinal vitamin and homocysteine levels in normal pregnancy

Evidence of the impact of maternal nutritional status on pregnancy outcome is increasing. However, reference values for vitamin and homocysteine concentrations in maternal blood during normal pregnancy are scarce, and are lacking for the preconceptional period and early pregnancy. Thus, in a longitudinal study we evaluated vitamin and homocysteine concentrations in 102 nulliparous women with an uneventful singleton pregnancy and normal outcome not using supplements. The physiological changes in vitamin and homocysteine concentrations in blood were determined from the preconceptional period throughout pregnancy until 6 weeks post-partum. The vitamins evaluated comprised retinol, thiamin, riboflavin, pyridoxal 5'-phosphate, folate in serum and erythrocytes, vitamin B12 and alpha-tocopherol. The plasma homocysteine concentration was also measured, considering the essential roles of folate, vitamin B6 and vitamin B12 in homocysteine metabolism. The concentrations of retinol, thiamin, pyridoxal 5'-phosphate serum folate and vitamin B12 decreased during pregnancy. In contrast, the concentrations of riboflavin, alpha-tocopherol, and folate in erythrocytes increased or showed only minor changes. Homocysteine concentrations also remained approximately constant during pregnancy. These observations emphasize the importance of preconceptional and post-partum concentrations of vitamins in the evaluation of pregnancy-induced changes. These data have provided valuable reference values for vitamins and homocysteine before, during and after pregnancy in order to contribute to better diagnosis of maternal deficiencies and to study further the relationship between maternal vitamin status and adverse course and outcome of pregnancy.     

Institutionalized elderly women have lower food intake than do those living more independently (Dutch Nutrition Surveillance System).

The habitual intake of energy and nutrients (assessed through dietary history) among elderly women (aged 65 and over) living in a nursing home (n = 54), elderly women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and elderly women living independently (n = 52) was evaluated within the framework of the Dutch Nutrition Surveillance System. Intake of energy and nutrients was lowest among women in the nursing home and highest among those living independently. Almost all differences in absolute intake found were significant, both unadjusted and adjusted for age. In the nursing home the intake of energy and nutrients was lower at higher age. In qualitative terms the differences among the groups of women were less striking. Mean daily intakes of iron, vitamin A, thiamin, vitamin B6 and vitamin C were below the Dutch recommended dietary allowances (RDAs) among the nursing home women. Several interrelationships among nutrient intakes were found, low intake levels clustering somewhat among elderly subjects. Our data indicate that these nutritional risks are due to a lower food intake resulting in a lower intake of energy and nutrients, and owing to differences in food choice resulting in a lower nutrient density. We conclude that it is difficult to design a diet containing all essential nutrients at the RDA level in a nursing home with residents who have a relatively low intake of energy, especially among those at higher age.     

Institutionalized elderly women have lower food intake than do those living more independently (Dutch Nutrition Surveillance System).

The habitual intake of energy and nutrients (assessed through dietary history) among elderly women (aged 65 and over) living in a nursing home (n = 54), elderly women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and elderly women living independently (n = 52) was evaluated within the framework of the Dutch Nutrition Surveillance System. Intake of energy and nutrients was lowest among women in the nursing home and highest among those living independently. Almost all differences in absolute intake found were significant, both unadjusted and adjusted for age. In the nursing home the intake of energy and nutrients was lower at higher age. In qualitative terms the differences among the groups of women were less striking. Mean daily intakes of iron, vitamin A, thiamin, vitamin B6 and vitamin C were below the Dutch recommended dietary allowances (RDAs) among the nursing home women. Several interrelationships among nutrient intakes were found, low intake levels clustering somewhat among elderly subjects. Our data indicate that these nutritional risks are due to a lower food intake resulting in a lower intake of energy and nutrients, and owing to differences in food choice resulting in a lower nutrient density. We conclude that it is difficult to design a diet containing all essential nutrients at the RDA level in a nursing home with residents who have a relatively low intake of energy, especially among those at higher age.     

Urinary 4-pyridoxic acid excretion in 24-hour versus random urine samples as a measurement of vitamin B6 status in humans

Urinary excretion of 4-pyridoxic acid (4PA) in 19 men (n = 5) and women (n = 14) was measured to evaluate the validity of determining the 4PA/creatinine ratio in random urine samples as an alternative to total 24-h 4PA excretion in assessing vitamin B6 nutritional status. The relationships among dietary vitamin B6 intake, 4PA excretion, plasma pyridoxal 5'-phosphate levels, and erythrocyte aspartate aminotransferase activity and in vitro stimulation by added plasma pyridoxal 5'-phosphate were examined. The subjects consumed all meals for 3 days in a metabolic unit, and protein intake was kept constant. Plasma pyridoxal 5'-phosphate concentration was positively correlated with vitamin B6 intake of the previous day (r = 0.61, p less than 0.01). There was a positive correlation (r = 0.59, p less than 0.01) between total 4PA and 4PA/creatinine in the 24-h urine samples. No difference (p greater than 0.05) in 4PA/creatinine between the 24-h samples and either morning or afternoon random samples taken the next day was found. These findings support the use of the 4PA/creatinine ratio in random urine samples as an alternative to 24-h urinary 4PA excretion.     

Nutrition and aging: nutritional status of “apparently healthy” elderly (Dutch nutrition surveillance system).

In a nationwide survey the nutritional status was assessed of 539 apparently healthy, independently living elderly aged 65-79 years. Anthropometric data showed no energy deficits. The prevalence of anemia was 4 and 1% among men and women, respectively. Many elderly showed a low level of 25-hydroxyvitamin D in plasma (less than 31 nmol/L: men 35%; women 43%), indicating a marginal status. Although the prevalence of low blood levels of folate, pyridoxal-5′-phosphate, and total carotenoids was higher among the elderly than among younger adults, clear (clinical) signs of nutritional deficiencies were not observed. Prevalence of obesity (13%), hypercholesterolemia (38%), and hypertension (63%) was found to be high, the percentages being higher for women than for men. Several indicators of the nutritional status appeared to differ among age groups. It is concluded that few differences can be considered as being due to physiological aging, which finding should be reflected in reference values for elderly people.     

Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program

Serum 25-hydroxyvitamin D (25(OH)D) status in older adults enrolled in community-based meal programs is not well characterized. The objective was to identify predictors of poor serum 25(OH)D status and the response to vitamin D supplementation in a convenience sample from the Older Americans Act Nutrition Program (OAANP) in northeast Georgia (N = 158, mean age = 77 years, 81% women, 69% Caucasian, 31% African American). Mean serum 25(OH)D was 55nmol/l, and intakes of vitamin D and calcium from foods were very low. Vitamin D insufficiency (25(OH)D 25- < 50 nmol/l) occurred in 36.7%. Vitamin D deficiency occurred in 8.2% (25(OH)D < 25 nmol/l) and was associated with low milk intake, low sunlight exposure, receiving meals at home, tobacco use, depression, dementia, antianxiety medication, poor instrumental activities of daily living, and low calf circumference (p < or = 0.05). When non-supplement users (n = 28) were given a multivitamin with vitamin D (10 microg/d) and calcium (450 mg/d) for 4 months, 25(OH)D increased from 50 to 78 nmol/l, the prevalence of poor vitamin D status (25(OH)D < 50 nmol/l) decreased from 61% to 14%, and serum alkaline phosphatase decreased by 10% (p < 0.01). High body weight appeared to attenuate the increase in 25(OH)D in response to the multivitamin supplement (p < or = 0.05). In conclusion, OAANP services did not prevent poor vitamin D and calcium status, but a supplement with vitamin D and calcium was beneficial.     

Seemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from a Mediterranean area

OBJECTIVE: We investigated vitamin D status in institutionalized elderly subjects by measuring serum 25-hydroxyvitamin D (25[OH]D) and its association with season and other factors: age, gender, nutritional status, cognitive function, functional ability, dietary intake, vitamin D supplement consumption, and disease. METHODS: The cross-sectional study included 86 subjects, 65-94 y of age (29 men and 57 women), who lived in three nursing homes in Murcia, a Spanish Mediterranean area. The Mini Nutritional Assessment, Short Portable Mental Status Questionnaire, and BI were used to evaluate nutritional status, functional ability, and cognitive function, respectively. Serum 25(OH)D concentrations were used to assess vitamin D status. The thresholds of inadequacy were considered to be <25 nmol/L (vitamin D deficiency) and <50 nmol/L (vitamin D insufficiency). RESULTS: Body mass index was 28.8 +/- 5.8 kg/m(2) (mean +/- SD). Vitamin D dietary intake was very much below the recommended dietary intake. The Mini Nutritional Assessment was 23.6 +/- 4.0, cognitive function was 7.8 +/- 1.9, and functional ability 82.9 +/- 23.1. The percentages of subjects with inadequate serum 25(OH)D concentrations were 58.2% and 32.6%, taking into consideration cutoffs of 50 and 25 nmol/L, respectively. Vitamin D deficiency was more common in women (40.3%) than in men (20.7%). Serum 25(OH)D concentrations varied significantly with the season in which the samples were taken, but not with the other factors analyzed. CONCLUSION: In this Mediterranean area, a substantial percentage of institutionalized subjects showed an inadequate vitamin D status, which could be remedied by the consumption of vitamin D-fortified foods and/or vitamin D supplements, especially during the summer months.     

Age, race and season predict vitamin D status in African American and white octogenarians and centenarians

Objective: Poor vitamin D status has been associated with osteoporosis, falls, cardiovascular diseases, cancer, autoimmune diseases, pain, nursing home placement, and other age-related conditions, but little is known about the prevalence and predictors of vitamin D status in those aged 80 and older. Thus, this study tested the hypothesis that vitamin D status would be 1) poorer in a population-based multi-ethnic sample of centenarians as compared with octogenarians and 2) predicted by specific dietary, demographic or environmental factors.Design: Cross-sectional population-based analyses.Setting: Northern Georgia in the United States.Participants: Men and women aged 80 to 89 (octogenarians, n=80) and 98 and older (centenarians, n=237).Measurements: Regression analyses were used to examine the associations of serum 25-hydroxyvitamin D [25(OH)D] with age, gender, race, living arrangements, dairy food intake, supplement intake, and season.Results: The prevalence of vitamin D insufficiency [25(OH)D<50 nmol/L] was higher in centenarians than in octogenarians (p<0.02). In logistic regression analyses, the risk of being vitamin D insufficient was significantly increased by being a centenarian vs. octogenarian (p<0.005) and by being African American vs. white (p<0.001) and decreased by taking a supplement with vitamin D (p<0.001) or by having vitamin D status measured in the summer or fall (each p<0.05), compared with spring.Conclusions: Centenarians and octogenarians are at high risk for vitamin D insufficiency for many of the same reasons identified in younger populations. Given the numerous potential adverse consequences of poor vitamin D status, efforts are needed to ensure vitamin D adequacy in these older adults.     

Antenatal supplementation with micronutrients and biochemical indicators of status and subclinical infection in rural Nepal

BACKGROUND: Previously we showed that women in rural Nepal experience multiple micronutrient deficiencies in early pregnancy. OBJECTIVE: This study examined the effects of daily antenatal micronutrient supplementation on changes in the biochemical status of several micronutrients during pregnancy. DESIGN: In Nepal, we conducted a randomized controlled trial in which 4 combinations of micronutrients (folic acid, folic acid + iron, folic acid + iron + zinc, and a multiple micronutrient supplement containing folic acid, iron, zinc, and 11 other nutrients) plus vitamin A, or vitamin A alone as a control, were given daily during pregnancy. In a subsample of subjects (n = 740), blood was collected both before supplementation and at approximately 32 wk of gestation. RESULTS: In the control group, serum concentrations of zinc, riboflavin, and vitamins B-12 and B-6 decreased, whereas those of copper and alpha-tocopherol increased, from the first to the third trimester. Concentrations of serum folate, 25-hydroxyvitamin D, and undercarboxylated prothrombin remained unchanged. Supplementation with folic acid alone or folic acid + iron decreased folate deficiency. However, the addition of zinc failed to increase serum folate, which suggests a negative inhibition; multiple micronutrient supplementation increased serum folate. Folic acid + iron + zinc failed to improve zinc status but reduced subclinical infection. Multiple micronutrient supplementation decreased the prevalence of serum riboflavin, vitamin B-6, vitamin B-12, folate, and vitamin D deficiencies but had no effect on infection. CONCLUSIONS: In rural Nepal, antenatal supplementation with multiple micronutrients can ameliorate, to some extent, the burden of deficiency. The implications of such biochemical improvements in the absence of functional and health benefits remain unclear.     

The composition and nutritional adequacy of subject-selected high carbohydrate, low fat diets in insulin-dependent diabetes mellitus

The composition and nutritional adequacy of subject-selected high carbohydrate, low fat diets were investigated in six women with insulin-dependent diabetes mellitus. Subjects were randomly assigned to begin either the experimental diet with 65% carbohydrate, 20% fat, and 15% protein for 6 wk, or a control diet with 45% carbohydrate, 40% fat, and 15% protein for 4 wk. All subjects completed both dietary periods in a cross-over experimental design. Subjects were allowed free selection in their choice of carbohydrate-rich foods. The resulting selections produced diets with 51% simple and 49% complex carbohydrates and 50 g of dietary fiber during the experimental diet. Similar proportions were also selected during the control diet. Blood chemistries revealed no significant changes in thiamin, riboflavin, vitamin B6, pyridoxal 5'-phosphate, ascorbate, vitamin E, calcium, selenium, or zinc concentrations between the two dietary periods. With the exception of vitamin B6, all vitamin and mineral values were within normal respective ranges. Vitamin B6 status, as assessed by pyridoxal 5'-phosphate, were below or just above the levels of marginal deficiency (2.2 nmol/100 ml) in four of the six individuals, but the lower level observed occurred independent of the dietary treatments. The present study demonstrates that subject-selected high carbohydrate, low fat diets were much lower in complex carbohydrates and fiber than diets previously tested. In addition, the concentration of several nutrients did not appear to be adversely affected by these diets.     

Biochemical and anthropometric evaluation of the nutritional status of 35-year-old Dutch men with reference to smoking and drinking habits

In 1986, sixty 35-year-old Dutch men (response 87%) provided information on medications, alcohol consumption and smoking habits. Length, body weight and blood pressure were determined. A blood sample was taken to determine serum cholesterol, HDL cholesterol and biochemical parameters of the vitamin, iron and trace element status (hematology, ferritin, vitamins A, B6, B12, folate, Zn, Se). Prevalence of overweight (body mass index greater than 27 kg/m2) was 15%, whereas 12% had high-risk cholesterol levels (greater than 6.4 mmol/l). Except for possibly selenium, no marginal values for the vitamin, iron and trace element status were found. Smokers had a higher hematocrit reading and mean corpuscular volume and lower mean corpuscular hemoglobin concentration (p less than 0.05). The nutritional status was not negatively influenced by (predominantly moderate) alcohol consumption (mean = 21 g/day). Positive associations with alcohol consumption were found for plasma folic acid (p less than 0.01) and plasma pyridoxal-5'-phosphate (p less than 0.001). This study shows that the most important nutritional risks in 35-year-old Dutch men are related to cardiovascular disease.     

Folate status worsens in recently institutionalized elderly people without evidence of functional deterioration

OBJECTIVE: To follow folate status, hematological and cognitive changes during the first year of institutionalization among elderly subjects. DESIGN: Prospective study. SETTING: Long-stay unit of the Dijon University Geriatric Hospital. SUBJECTS: Twenty women and four men older than 65 years admitted consecutively. MAIN OUTCOME MEASURES: Folate and vitamin B-6 dietary intake was evaluated by a five-day record on admission (day 1 or d 1), at day 45 (d 45), day 90 (d 90), day 135 (d 135), day 180 (d 180), day 360 (d 360). Circulating levels of folate, vitamin B-6, total homocysteine (tHcy), blood counts and cognitive performance were determined in parallel. RESULTS: From d 1 to d 360, mean folate and vitamin B-6 intakes remained below the French RDA and mean folate intakes decreased significantly (delta = 10.2%, p < 0.05). Mean plasma or erythrocyte folate decreased significantly (delta = 33.7%, p <0.05 and delta = -30.2%, p < 0.001, respectively) from d 1 to d 360; no significant change was observed for the other blood parameters. The incidence of folate deficiency increased (8% vs. 37% for plasma folate <6.8 nmol/L and 8% vs. 17% for erythrocyte folate <340 nmol/L) from d I to d 360. Mean plasma pyridoxal 5'-phosphate (PLP) remained <20 nmol/L during the one-year follow-up. There was no difference between genders for plasma tHcy. Although mean plasma tHcy was <14 micromol/L. plasma tHcy was >14 micromol/L in about one-third of the subjects. At each period, 50% or more subjects were anemic (Hct <35% in women and Hct <40% in men), but the anemia was normocytic (MCV <100 fL). Subjects had a moderate dementia at admission, and no change was observed during the study. CONCLUSIONS: Subjects were already vitamin B-6 deficient at admission. Folate status was impaired during the study. Low vitamin intakes were the main cause of vitamin B-6 deficiency and folate status deterioration. Hematology and mental status capacity were not aggravated by folate status deterioration. Plasma tHcy didn't appear to be an earlier predictor of folate deficiency.     

Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food

Background

Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world. Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women.

Methods

Iron biomarkers, 25-hydroxyvitamin D levels and dietary intake were measured in 123 iron-deficient menstruating women. A subgroup (n = 41) participated in a randomised double-blind placebo-controlled study of 16-weeks during winter. They consumed a placebo fruit juice (P) or iron-fortified fruit juice (F). Dietary intake, 25-hydroxyvitamin D, parathormone (PTH), bone alkaline phosphatase (ALP), aminoterminal telopeptide of collagen I (NTX) and iron biomarkers were determined.

Results

Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient. Transferrin saturation and 25-hydroxyvitamin D were positively correlated. Iron status improved in F, 25-hydroxyvitamin D decreased in F and P, and PTH, ALP and NTX levels were within the normal range and did not vary. Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation (a marker of iron supply to tissues) during iron recovery.

Conclusion

The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women. The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels; however, the increase in iron supply to tissues is lower if the women also present vitamin D deficiency. Although bone health does not seem to be affected in this group of women, correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health.     

Nutritional risk assessment and obesity in rural older adults: a sex difference

BACKGROUND: Many older Americans are overweight or obese, but it is unclear whether obesity is associated with other nutritional risk indicators. OBJECTIVE: This study investigated sex-associated differences in nutritional risk among community-dwelling, rural older adults and determined whether weight status [body mass index (BMI; in kg/m(2)) and waist circumference] was related to other measures of nutritional risk. DESIGN: This cross-sectional study explored relations between weight status and nutritional risk, which was determined on the basis of the Level II Screen, overall diet quality, nutrient intakes, and plasma biomarkers. RESULTS: Of the 179 subjects, 44% were overweight (BMI 25-29.9) and 35% were obese (BMI > 30). There were few differences in nutrient intakes between older men and women after we controlled for energy intake. In women, BMI was directly associated with multiple additional nutritional risk indicators, including the number of Level II items (r = 0.30), intakes of fat (r = 0.26) and saturated fat (r = 0.21), and homocysteine concentration (r = 0.25). Weight status in women was inversely associated with intakes of carbohydrates (r = -0.25), fiber (r = -0.35), folate (r = -0.24), magnesium (r = -0.29), iron (r = -0.22), and zinc (r = -0.23); Healthy Eating Index scores (r = -0.22); and plasma pyridoxal 5' phosphate (r = -0.30). Associations with waist circumference were similar. In men, weight status was associated only with plasma cobalamin (r = -0.33 for BMI) and pyridoxal 5' phosphate (r = -0.24 for waist circumference). CONCLUSIONS: Overweight and obese older women, particularly those living alone, may be at greater nutritional risk than are men with a high BMI. Targeted nutritional intervention emphasizing nutrient-dense food choices to improve dietary patterns may be warranted.     

Vitamins B6 and B12 and folate status in an adult Mediterranean population

OBJECTIVE: To assess the nutritional status for vitamins B(6) and B(12) and folate in an adult Mediterranean population, in order to identify patterns of intake, groups at risk for deficiency, and factors that might influence this risk. DESIGN: A cross-sectional epidemiological survey. SETTING: Andalusia, a western Mediterranean region in southern Spain. SUBJECTS: The study was carried out with a random sample of 3528 subjects (1813 men, 1715 women) who were between 25 and 60 y of age. Blood samples were obtained for biochemical assays in a random subsample of 384 subjects (183 men, 201 women). INTERVENTIONS: Food consumption was assessed by 48-h recall. Vitamin B(6) was measured as alpha erythrocyte aspartate aminotransferase activation coefficient (alphaEAST); vitamin B(12) and folate concentrations were measured in plasma. RESULTS: Energy and vitamin intakes were significantly higher in men than in women. In men, intakes were below two-thirds of the RDA in 10.8, 2.9 and 22.6% for B(6), B(12) and folate, respectively. The corresponding figures in women were 16.7, 5.1 and 23.5% for vitamins B(6), B(12) and folate. Age, place of residence and educational level, alcohol use and smoking were also associated with differences in the intake of these nutrients. Biochemical analyses showed that vitamins B(6), B(12) and folate status was acceptable in 75.7, 89.1 and 57.6% of the population, respectively. Plasma concentration of folate was significantly higher in women. CONCLUSION: Our results provide a precise estimate of the nutritional status for vitamins B(6), B(12) and folate in the adult population of southern Spain. Factors such as age, place of residence, level of education and smoking can increase the risk of inadequate intake of some nutrients. However, these factors did not affect biochemical indexes of nutritional status in the present study. SPONSORSHIP: Dirección General de Salud Pública and the Health Council of the Andalusian Regional Government.