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Vitamin D status and its predictors in New Zealand aged-care residents eligible for a government-funded universal vitamin D supplementation programme

  • Sue O MacDonell (a1), Jody C Miller (a1), Michelle J Harper (a1), Debra L Waters (a2) and Lisa A Houghton (a1)...

Abstract

Objective

The provision of prescribed vitamin D to all aged-care residents has been implemented in New Zealand as part of a government-led falls prevention programme. To our knowledge, there has been no evaluation of this universal programme on vitamin D status and functional and health outcomes. Thus, we aimed to determine 25-hydroxyvitamin D (25(OH)D) concentrations and their predictors in aged-care residents across the country and to investigate whether the government-funded programme was associated with adequate vitamin D status.

Design

Cross-sectional survey of sociodemographic, biochemical, anthropometric, dietary and health characteristics. Blood samples were analysed for serum 25(OH)D and other biochemical measures. Multiple regression was used to examine predictors of vitamin D status.

Setting

Sixteen residential aged-care facilities throughout New Zealand.

Subjects

Residents aged ≥60 years with residency duration >12 weeks (n 309).

Results

Mean serum 25(OH)D was 89·9 (95 % CI 85·2, 94·5) nmol/l and monthly supplements (1250 µg (50 000 IU)) were taken by 75 % of all residents. Of those not taking a funded supplement, 65·3 % had serum 25(OH)D <50 nmol/l compared with only 1·5 % of supplement users. Being female, residing at lower latitude, increasing duration of aged-care residency and raised serum α1-acid glycoprotein were positively associated with higher 25(OH)D concentrations. Supplemental vitamin D from all sources was the strongest predictor, increasing serum 25(OH)D levels by more than 70 nmol/l. Furthermore, 25 % of participants had serum 25(OH)D levels >125 nmol/l.

Conclusions

Residents taking supplemental vitamin D had adequate vitamin D status; however monitoring of long-term supplementation should be considered, due to the high proportion of participants with high serum 25(OH)D levels.

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Copyright

Corresponding author

* Corresponding author: Email: sue.macdonell@otago.ac.nz

References

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1. MacLaughlin, J & Holick, MF (1985) Aging decreases the capacity of human skin to produce vitamin D3 . J Clin Invest 76, 15361538.
2. Institute of Medicine (2011) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press.
3. National Health and Medical Research Council (2005) Nutrient Reference Values for Australia and New Zealand. Canberra: Department of Health and Ageing.
4. Reid, IR, Bolland, MJ & Grey, A (2014) Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 383, 146155.
5. Scientific Advisory Committee on Nutrition (2015) Draft Vitamin D and Health Report Scientific Consultation: 22 July to 23 September 2015. London: SACN.
6. Dawson-Hughes, B (2012) Serum 25-hydroxyvitamin D and muscle atrophy in the elderly. Proc Nutr Soc 71, 4649.
7. Bouillon, R, Schoor, NMV, Gielen, E et al. (2013) Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab 98, E1283E1304.
8. Rolland, Y, de Souto Barreto, P, van Kan, GA et al. (2013) Vitamin D supplementation in older adults: Searching for specific guidelines in nursing homes. J Nutr Health Aging 17, 402412.
9. Pabst, G, Zimmermann, AK, Huth, C et al. (2015) Association of low 25-hydroxyvitamin D levels with the frailty syndrome in an aged population: results from the KORA-Age Augsburg study. J Nutr Health Aging 19, 258264.
10. De Vita, F, Lauretani, F, Bauer, J et al. (2014) Relationship between vitamin D and inflammatory markers in older individuals. Age (Dordr) 36, 9694.
11. Balion, C, Griffith, LE, Strifler, L et al. (2012) Vitamin D, cognition, and dementia: a systematic review and meta-analysis. Neurology 79, 13971405.
12. Toffanello, ED, Coin, A, Perissinotto, E et al. (2014) Vitamin D deficiency predicts cognitive decline in older men and women: the Pro.V.A. Study. Neurology 83, 22922298.
13. Annweiler, C, Dursun, E, Féron, F et al. (2015) ‘Vitamin D and cognition in older adults’: updated international recommendations. J Intern Med 277, 4557.
14. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults (2014) Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc 62, 147152.
15. Bolland, MJ, Grey, A, Gamble, GD et al. (2014) The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2, 307320.
16. Panel on Prevention of Falls in Older Persons, American Geriatics Society & British Geriatrics Society (2011) Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59, 148157.
17. Accident Compensation Corporation (2011) Vitamin D Programme: Information for Pharmacists. http://www.acc.co.nz/PRD_EXT_CSMP/idcplg?IdcService=GET_FILE&dID=59641&dDocName=WPC087748&allowInterrupt=1 (accessed October 2015).
18. Campbell, AJ & Robertson, MC (2010) Comprehensive approach to fall prevention on a national level: New Zealand. Clin Geriatr Med 26, 719731.
19. Accident Compensation Corporation (2011) The New Zealand Injury Prevention Outcomes Report – June 2011. Wellington: ACC.
20. Willaims, M (2012) Increasing routine vitamin D prescription to aged-care residents in New Zealand: giving resident the D-fence against falls. Inj Prev 18, A65A66.
21. Nestle Nutrition Institute (2013) A guide to completing the Mini Nutritional Assessment – Short Form. http://www.mna-elderly.com/forms/mna_guide_english_sf.pdf (accessed September 2013).
22. Ministry of Health (2012) Vitamin D Status of New Zealand Adults: Findings from the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Health.
23. Wood, AD, Secombes, KR, Thies, F et al. (2014) A parallel group double-blind RCT of vitamin D3 assessing physical function: is the biochemical response to treatment affected by overweight and obesity? Osteoporos Int 25, 305315.
24. Gibson, RS (2005) Evaluation of nutrient intakes and diets. In Principles of Nutritional Assessment, 2nd ed., pp. 197232. New York: Oxford University Press.
25. Dodd, KW, Guenther, PM, Freedman, LS et al. (2006) Statistical methods for estimating usual intake of nutrients and foods: a review of the theory. J Am Diet Assoc 106, 16401650.
26. New Zealand Formulary (NZF) v33 (2015) www.nzf.org.nz (accessed March 2015).
27. Holick, MF & Chen, TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87, issue 4, 1080S1086S.
28. Rubenstein, LZ, Harker, JO, Salvà, A et al. (2001) Screening for undernutrition in geriatric practice: developing the Short-Form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 56, M366M372.
29. Romero-Ortuno, R, Lawlor, BA & Kenny, RA (2010) A Frailty Instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 10, 12.
30. Roberts, HC, Syddall, HE, Sparkes, J et al. (2014) Grip strength and its determinants among older people in different healthcare settings. Age Ageing 43, 241246.
31. Maunsell, Z, Wright, DJ & Rainbow, SJ (2005) Routine isotope-dilution liquid chromatography–tandem mass spectrometry assay for simultaneous measurement of the 25-hydroxy metabolites of vitamins D2 and D3 . Clin Chem 51, 16831690.
32. Ministry of Health, Cancer Society of New Zealand (2012) Consensus Statement on Vitamin D and Sun Exposure in New Zealand. Wellington: Ministry of Health.
33. Kidney Health Australia (2015) eGFR Calculator. http://www.kidney.org.au/healthprofessionals/gfrcalculatorckdepi/tabid/803/default.aspx (accessed June 2015).
34. Royston, P & Altman, DG (1994) Regression using fractional polynomials of continuous covariates: parsimonious parametric modelling. J R Stat Soc Ser C Appl Stat 43, 429467.
35. Sambrook, PN, Cameron, ID, Cumming, RG et al. (2002) Vitamin D deficiency is common in frail institutionalised older people in northern Sydney. Med J Aust 176, 560.
36. Wigg, AER, Prest, C, Slobodian, P et al. (2006) A system for improving vitamin D nutrition in residential care. Med J Aust 185, 195198.
37. Woods, JL, Walker, KZ, Iuliano-Burns, S et al. (2009) Malnutrition on the menu: nutritional status of institutionalised elderly Australians in low-level care. J Nutr Health Aging 13, 693698.
38. Grieger, J, Nowson, C & Ackland, M (2007) Anthropometric and biochemical markers for nutritional risk among residents within an Australian residential care facility. Asia Pac J Clin Nutr 16, 178186.
39. Cameron, ID, Gillespie, LD, Robertson, MC et al. (2012) Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 12, CD005465.
40. Veleva, BI, Chel, VG & Achterberg, WP (2014) Efficacy of daily 800 IU vitamin D supplementation in reaching vitamin D sufficiency in nursing home residents: cross-sectional patient file study. BMC Geriatr 14, 103.
41. Wijnen, H, Salemink, D, Roovers, L et al. (2015) Vitamin D supplementation in nursing home patients: randomized controlled trial of standard daily dose versus individualized loading dose regimen. Drugs Aging 32, 371378.
42. Chel, V, Wijnhoven, HAH, Smit, JH et al. (2008) Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. Osteoporos Int 19, 663671.
43. Bjorkman, MP, Sorva, AJ & Tilvis, RS (2009) C-reactive protein and fibrinogen of bedridden older patients in a six-month vitamin D supplementation trial. J Nutr Health Aging 13, 435439.
44. McCarroll, K, Beirne, A, Casey, M et al. (2015) Determinants of 25-hydroxyvitamin D in older Irish adults. Age Ageing 44, 847853.
45. Glendenning, P, Zhu, K, Inderjeeth, C et al. (2012) Effects of three-monthly oral 150,000 IU cholecalciferol supplementation on falls, mobility, and muscle strength in older postmenopausal women: a randomized controlled trial. J Bone Miner Res 27, 170176.
46. Bacon, CJ, Gamble, GD, Horne, AM et al. (2009) High-dose oral vitamin D3 supplementation in the elderly. Osteoporos Int 20, 14071415.
47. Durazo-Arvizu, RA, Dawson-Hughes, B, Sempos, CT et al. (2010) Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older. J Nutr 140, 595599.
48. Di Monaco, M, Castiglioni, C, Vallero, F et al. (2013) Parathyroid hormone response to severe vitamin D deficiency is sex associated: an observational study of 571 hip fracture inpatients. J Nutr Health Aging 17, 180184.
49. Villareal, DT, Apovian, CM, Kushner, RF et al. (2005) Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res 13, 18491863.
50. Flicker, L, Mead, K, MacInnis, RJ et al. (2003) Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc 51, 15331538.
51. McKenzie, RL, Bodeker, GE, Keep, DJ et al. (1996) UV radiation in New Zealand: measure North to South differences, and relationship to other latitudes. Weather Clim 16, 1726.
52. Sambrook, PN, Cameron, ID, Chen, JS et al. (2012) Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial. Osteoporos Int 23, 615624.
53. Mellenthin, L, Wallaschofski, H, Grotevendt, A et al. (2014) Association between serum vitamin D concentrations and inflammatory markers in the general adult population. Metabolism 63, 10561062.
54. Friis, H, Range, N, Changalucha, J et al. (2013) Vitamin D status among pulmonary TB patients and non-TB controls: a cross-sectional study from Mwanza, Tanzania. PLoS ONE 8, e81142.
55. Mason, C, Xiao, L, Imayama, I et al. (2011) Effects of weight loss on serum vitamin D in postmenopausal women. Am J Clin Nutr 94, 95103.
56. Guessous, I, McClellan, W, Kleinbaum, D et al. (2014) Comparisons of serum vitamin D levels, status, and determinants in populations with and without chronic kidney disease not requiring renal dialysis: a 24-hour urine collection population-based study. J Ren Nutr 24, 303312.
57. Accident Compensation Corporation (2013) Vitamin D supplements linked to big drop in falls in aged care facilities. http://www.acc.co.nz/news/WPC119005 (accessed December 2014).
58. Rolland, Y, Abellan Van Kan, G, Hermabessiere, S et al. (2009) Descriptive study of nursing home residents from the REHPA network. J Nutr Health Aging 13, 679683.
59. Yanamadala, M, Heflin, MT, White, HK et al. (2012) Ensuring vitamin D supplementation in nursing home patients – a quality improvement project. J Nutr Gerontol Geriatr 31, 158171.
60. Viveky, N, Toffelmire, L, Thorpe, L et al. (2012) Use of vitamin and mineral supplements in long-term care home residents. Appl Physiol Nutr Metab 37, 100105.
61. Alamri, SH, Kennedy, CC, Marr, S et al. (2015) Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada. BMC Geriatr 15, 94.
62. Accident Compensation Corporation (2008) Vitamin D – a proven D-fence against falls. http://ndhadeliver.natlib.govt.nz/delivery/DeliveryManagerServlet?dps_pid=IE1035372&dps_custom_att_1=ilsdb (accessed December 2015).
63. Accident Compensation Corporation (2008) Stay on your feet and stay active with a little help from vitamin D. http://ndhadeliver.natlib.govt.nz/delivery/DeliveryManagerServlet?dps_pid=IE1035386&dps_custom_att_1=ilsdb (accessed December 2015).
64. Maher, RL, Hanlon, JT & Hajjar, ER (2014) Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 13, 5765.
65. Sanders, KM, Stuart, AL, Williamson, EJ et al. (2010) Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303, 18151822.
66. Hollis, BW & Wagner, CL (2013) The role of the parent compound vitamin D with respect to metabolism and function: why clinical dose intervals can affect clinical outcomes. J Clin Endocrinol Metab 98, 46194628.
67. Pfeiffer, CM, Sternberg, MR, Schleicher, RL et al. (2013) The CDC’s Second National Report on Biochemical Indicators of Diet and Nutrition in the US Population is a valuable tool for researchers and policy makers. J Nutr 143, issue 6, 938S947S.
68. Deplas, A, Debiais, F, Alcalay, M et al. (2004) Bone density, parathyroid hormone, calcium and vitamin D nutritional status of institutionalized elderly subjects. J Nutr Health Aging 8, 400404.
69. Gallagher, JC, Yalamanchili, V & Smith, LM (2013) The effect of vitamin D supplementation on serum 25OHD in thin and obese women. J Steroid Biochem Mol Biol 136, 195200.
70. Pfeifer, M, Begerow, B, Minne, HW et al. (2000) Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 15, 11131118.
71. Seamans, KM & Cashman, KD (2009) Existing and potentially novel functional markers of vitamin D status: a systematic review. Am J Clin Nutr 89, issue 6, 1997S2008S.
72. PHARMAC (2016) Online Pharmaceutical Schedule. http://pharmac.govt.nz/patients/PharmaceuticalSchedule/Schedule (accessed April 2016).
73. Grant Thornton New Zealand Ltd (2010) Aged Residential Care Service Review. Wellington: Grant Thornton New Zealand Ltd.

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