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L2: nutrition in older persons

Q: When are people considered deficient in vitamin D? (which serum value)

<50 nmol/l serum 25(OH)D levels

35 important questions on L2: nutrition in older persons

How much IU is 1 µg vitamin D?

40 IU

How much nmol/l is 1 ng/l vitamin D?

2.5 nmol/l

How much ng/l is 2.5 nmol/l vitamin D?

1 ng/l

What are the most important dietary sources of vitamin D in the netherlands?

- fats and oils (about 30%)
- meat (about 15%)
- dietary supplements (15%)
- fish and shellfish (9%)

What is the mean dietary intake of vitamin D for a man 51-96 years?

3,8 µg per day

What is the mean dietary intake of vitamin D for a woman 51-96 years?

2,9 µg per day

What is the mean dietary intake of vitamin D for a woman >70 years?

3,2 µg per day

How much vitamin D do we get on average through sun exposure?

About 6-7 µg per day for average dutch person.

Why do we tell older persons to take a supplement of vitamin D and not to eat more or go more in the sun?

Because its nearly impossible to reach the daily requirement of vitamin D through food.
Also, the sun is harmful if its too much, because of the risk on skin cancer.
And the sun also breaks down vitamin D again.

What is the RDI for vitamin D for people >70 years?

20 µg

What is the AI for vitamin D for people 18-69y years?

10 µg
With a daily intake of around 3 µg and around 6-7 µg from sun, this is feasable.

Name 2 reasons why its not recommended to people >70 y to eat more fish

- You would need 450 g of fresh salmon a day with no UV exposure, or 250 g with UV exposure.
- It is not sustainable for people to eat so much fish. This is harmful to the environment.

How much fortified milk and egg yolks would people >70y need to eat to reach 20 µg vitamin D daily?

- 2 L fortified milk with no UV exposure, 1,1 L with exposure.
- 40 egg yolks with no UV exposure, 23 egg yolks with exposure.
This is not feasable.

What is the supplementation advice for vitamin D?

- all men and women 70+ years: 20 µg per day.
- Women between 50-70 years: 10 µg per day

- people with fair skin but no UV exposure, or people with dark skin: 4 - 70 y: 10 µg; 70+ years: 20 µg

How many % of older persons adhere to the guideline of vitamin D supplementation and why?

About 5% of 215 asked adults, 36% used some kind of vitamin D supplement.
people that dont take it said they ate healthy, or are healthy, or never thought about it.

When are people considered deficient in vitamin D? (which serum value)

<50 nmol/l serum 25(OH)D levels

How much people >65 years have a vitamin D deficiency?

About 45% have serum vitamin D of <50 µg

Why are vitamin D levels in south of europe lower than in the north?

Because in the south it can be too hot so they cover up. Also they think they get tnough sun so dont take supplement. In the north there is more attention to it.

Who do obese people have a higher risk of vitamin D deficiency?

Because the vitamin D is stored in fat cells and not as present in the bloodstream.

Name 2 reasons we do not advice obese people to take a supplement for vitamin D, even though they are more likely to be deficient

- we know that the vitamin D is there, stored in bodyfat. So they can use it when the body needs it.
- Obese persons do not seem to have an increased risk for vitamin D related outcomes, such as osteoporosis, falls and fractures.

How much weightloss do obese people have to reach to get a significant increase in serum 25(OH)D?

>15% weight loss. Then you can get an increase of 7.7 (±7.1) ng/ml 25(OH)D.
less weightloss doesnt result in significant increase of serum vit D.

Name 3 health outcomes related to vitamin D that have sufficient evidence

- skeletal health (bone mineral density, BMD)
- falls
- mortality

What is the evidence of vitamin D supplements+calcium on bone mineral density?

Vitamin D3 supplement + calcium have a beneficial effect on BMD vs placebo at 1 year (meta-analysis RCT's)

What is the evidence of vitamin D supplementation and fractures?

- only vitamin D: no effect on fractures
- vitamin D + calcium: beneficial effect of vit D + calcium vs placebo.
- only calcium: no effect on frctures.
So: only vit D + calcium have beneficial effect on fractures. Only vit D or only calcium dont.

What is the dose of vitamin D supplementation to get an effect on reduced risk of fractures?

400 IU vitamin D (10 µg) no effect
800 IU vitamin D (20 µg) beneficial effect

What is the body of evidence of vitamin D supplementation on bone mineral density and fractures?

- Vit d has positive effect on bone health (bone mineral density)
- vitamin D supplementation prevents (hip) fractures, but only together with calcium. Could be in diet or supplementation. The dose has to be >800 IU (20 µg)

What is the evidence of vitamin D supplementation on falls?

- vit D may prevent falls, but only togehter with calcium.
- dose has to be >800 IU (>20 µg)

What is the potential mechanism behind vitamin D supplementation and fallprevention?

- vitamin D is involved in muscle strength and the regulation of protein synthesis. Enough vitamin D is important for maintaining muscle strength and mass.
Vit D supplementaiton may lead to prevention of muscle weakness.

What is the evidence of vitamin D supplementation and mortality? Why is it not really feasable?

Only vit D with calcium has a lower odds on mortality, but you have to treat 151 persons to prevent 1 death.

What is the upper level of vitamin D?

4000 IU (100 µg) per day

Name 3 adverse outcomes of vitamin D intoxication

- calcium buildup in the blood and body. This could lead to nausea, vomiting, muscle weakness, dehydration, constipation, kidney stones.
- extremely high levels can lead to: kdiney failure, irregular heartbeat, death

What are the results of the VITAL trial of vitamin D and several health outcomes?

Vitamin D supplementation had no effect on several health outcomes,
primary: cancer and major cardiovascular event. No effect
other:
falls, depression, heart failure, migraine, depression, etc. No effect.

Why was vitamin D associated with covid 19?

A lot of people in the ICU because of covid have a vitamin D deficiency. Then the hypothesis was that vitamin D could protect from severe covid 19 infection.
but: people on the ICU with covid were: older, overweight, pshysical inactive, with chronic disease.
these are all risk factors for low vitamin D status.

What is the evidence of vitamin D and covid 19?

There is no evidence that vitamin D supplementation lowers the risk of (severe) covid 19

Which type of vitamin D cannot be used to establish a deficiency and why?

1,25(OH)2D cannot be used. This is the biologically active form of vitamin D. This cannot be used because the body makes sure the serum levels of this compound are sufficient to maintain calcium homeostasis. Thus, measuring this compound does not give a good representation of vitamin D in the body.
Rather, 25(OH)D is used to establish a deficiency.

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Public health nutrition

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