Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Vitamin D intake and bone mineral density in Korean adults: analysis of the 2009-2011 Korea National Health and Nutrition Examination Survey

  • Hyejin, You (Department of Food and Nutrition, Chungnam National University) ;
  • Hye Ran, Shin (Department of Food and Nutrition, Chungnam National University) ;
  • SuJin, Song (Department of Food and Nutrition, Hannam University) ;
  • Sun Yung, Ly (Department of Food and Nutrition, Chungnam National University)
  • Received : 2021.04.26
  • Accepted : 2021.12.20
  • Published : 2022.12.01
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Abstract

BACKGROUND/OBJECTIVES: The prevalence of vitamin D deficiency in Koreans is quite high; however, until recently, Korean National Health and Nutrition Survey (KNHANES) had not analyzed the vitamin D intake among Koreans. Additionally, the Korean Dietary Reference Intake for vitamin D was established based on insufficient evidence. Therefore, we investigated vitamin D intake and its relationship with bone mineral density (BMD) in Korean adults using the combined data from the 2009-2011 KNHANES. MATERIALS AND METHODS: This study was conducted in 11,949 healthy adults. Vitamin D intake was assessed using a 24-h recall method, and the BMD was measured using dual-energy X-ray absorptiometry. RESULTS: The prevalence of vitamin D deficiency (< 20 ng/mL) was 64% in men and 77% in women. In women aged ≥ 50 yrs and men aged < 50 yrs, there was a significant positive correlation between vitamin D intake and serum 25-hydroxyvitamin D level after sun exposure adjustment. The BMD of postmenopausal women aged ≥ 50 yrs with a vitamin D intake of 5 ㎍/day or more was significantly higher than that of women with intake less than 5 ㎍/day. After adjusting for age, energy, and calcium intake, the vitamin D intake of the osteoporotic group was significantly lower than that of the osteopenia group in women. CONCLUSIONS: Since the relationship between vitamin D intake and BMD was observed in women aged ≥ 50 yrs, further research is needed to clarify these findings using cohort or randomized controlled trials.

Keywords

Acknowledgement

The authors wish to thank the Korea Ministry of Health and Welfare, and Korea Centers for Disease Control & Prevention for allowing their survey data to be analyzed in this study.

References

  1. Lips P, van Schoor NM. The effect of vitamin D on bone and osteoporosis. Best Pract Res Clin Endocrinol Metab 2011;25:585-91.   https://doi.org/10.1016/j.beem.2011.05.002
  2. Shin HA, Om AS. The correlation between dietary intakes of calcium and vitamin D and osteoporosis, hypertension and diabetes mellitus. J Milk Sci Biotechnol 2009;27:17-23. 
  3. Candido FG, Bressan J. Vitamin D: link between osteoporosis, obesity, and diabetes? Int J Mol Sci 2014;15:6569-91.   https://doi.org/10.3390/ijms15046569
  4. Maki KC, Rubin MR, Wong LG, McManus JF, Jensen CD, Marshall JW, Lawless A. Serum 25-hydroxyvitamin D is independently associated with high-density lipoprotein cholesterol and the metabolic syndrome in men and women. J Clin Lipidol 2009;3:289-96.   https://doi.org/10.1016/j.jacl.2009.07.003
  5. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women's Health Study. Arthritis Rheum 2004;50:72-7.   https://doi.org/10.1002/art.11434
  6. Cantorna MT, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr 2004;80:1717S-1720S.   https://doi.org/10.1093/ajcn/80.6.1717S
  7. Freedman DM, Dosemeci M, McGlynn K. Sunlight and mortality from breast, ovarian, colon, prostate, and non-melanoma skin cancer: a composite death certificate based case-control study. Occup Environ Med 2002;59:257-62.   https://doi.org/10.1136/oem.59.4.257
  8. Holick MF. The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 2017;18:153-65.   https://doi.org/10.1007/s11154-017-9424-1
  9. Prentice A, Goldberg GR, Schoenmakers I. Vitamin D across the lifecycle: physiology and biomarkers. Am J Clin Nutr 2008;88:500S-506S.   https://doi.org/10.1093/ajcn/88.2.500s
  10. Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DE, Atkinson SA, Josse RG, Feldman S, Kline GA, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ 2010;182:E610-8.   https://doi.org/10.1503/cmaj.080663
  11. Del Valle HB, Yaktine AL, Taylor CL, Ross AC; Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academies Press; 2011. 
  12. World Health Organization. Prevention and Management of Osteoporosis: Report of a WHO Scientific Group. Geneva: World Health Organization; 2003. 
  13. Yoo K, Cho J, Ly S. Vitamin D intake and serum 25-hydroxyvitamin D levels in Korean adults: analysis of the 2009 Korea National Health and Nutrition Examination Survey (KNHANES IV-3) using a newly established vitamin D database. Nutrients 2016;8:610.  
  14. Lee MK, Yoon BK, Chung HY, Park HM. The serum vitamin D nutritional status and its relationship with skeletal status in Korean postmenopausal women. Korean J Obstet Gynecol 2011;54:241-6.   https://doi.org/10.5468/KJOG.2011.54.5.241
  15. Park EJ, Joo IW, Jang MJ, Kim YT, Oh K, Oh HJ. Prevalence of osteoporosis in the Korean population based on Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. Yonsei Med J 2014;55:1049-57.   https://doi.org/10.3349/ymj.2014.55.4.1049
  16. Ha YC. Epidemiology of osteoporosis in Korea. J Korean Med Assoc 2016;59:836-41.  https://doi.org/10.5124/jkma.2016.59.11.836
  17. Lee EJ, Son SM. Dietary risk factors related to bone mineral density in the postmenopausal women with low bone mineral density. Korean J Community Nutr 2004;9:644-53. 
  18. Hwang YC, Ahn HY, Jeong IK, Ahn KJ, Chung HY. Optimal serum concentration of 25-hydroxyvitamin D for bone health in older Korean adults. Calcif Tissue Int 2013;92:68-74.   https://doi.org/10.1007/s00223-012-9669-3
  19. Delvin EE, Imbach A, Copti M. Vitamin D nutritional status and related biochemical indices in an autonomous elderly population. Am J Clin Nutr 1988;48:373-8.   https://doi.org/10.1093/ajcn/48.2.373
  20. Villareal DT, Civitelli R, Chines A, Avioli LV. Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. J Clin Endocrinol Metab 1991;72:628-34.   https://doi.org/10.1210/jcem-72-3-628
  21. Kim MY, Kim MJ, Ly SY. Vitamin D intake, serum 25OHD, and bone mineral density of Korean adults: based on the Korea National Health and Nutrition Examination Survey (KNHANES, 2011). J Nutr Health 2016;49:437-46.  
  22. Ohta H, Kuroda T, Tsugawa N, Onoe Y, Okano T, Shiraki M. Optimal vitamin D intake for preventing serum 25-hydroxyvitamin D insufficiency in young Japanese women. J Bone Miner Metab 2018;36:620-5.   https://doi.org/10.1007/s00774-017-0879-7
  23. Kim H, Beom SH, Lee SH, Koh JM, Kim BJ, Kim TH. Differential association of dietary fat intake with DXA-based estimates of bone strength according to sex in the KNHANES IV population. Arch Osteoporos 2020;15:62.  
  24. Yoo KO, Kim MJ, Ly SY. Association between vitamin D intake and bone mineral density in Koreans aged ≥ 50 years: analysis of the 2009 Korea National Health and Nutrition Examination Survey using a newly established vitamin D database. Nutr Res Pract 2019;13:115-25.   https://doi.org/10.4162/nrp.2019.13.2.115
  25. Jung SJ, Hwangbo Y, Jung JH, Kim J, Kim H, Jeong KH, Lee DW, Cho SH, Kim HW. Recent trends in serum vitamin D levels among Korean population: Korea National Health and Nutrition Examination Survey 2008-2014. Korean J Clin Geri 2018;19:55-62.   https://doi.org/10.15656/kjcg.2018.19.1.55
  26. Yoon JS, Song MK. Vitamin D intake, outdoor activity time and serum 25-OH vitamin D concentrations of Korean postmenopausal women by season and by age. Korean J Community Nutr 2015;20:120-8.   https://doi.org/10.5720/kjcn.2015.20.2.120
  27. Freisling H, Fahey MT, Moskal A, Ocke MC, Ferrari P, Jenab M, Norat T, Naska A, Welch AA, Navarro C, et al. Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries. J Nutr 2010;140:1280-6.   https://doi.org/10.3945/jn.110.121152
  28. Harnack LJ, Steffen L, Zhou X, Luepker RV. Trends in vitamin D intake from food sources among adults in the Minneapolis-St Paul, MN, metropolitan area, 1980-1982 through 2007-2009. J Am Diet Assoc 2011;111:1329-34.   https://doi.org/10.1016/j.jada.2011.06.009
  29. Lamberg-Allardt C, Brustad M, Meyer HE, Steingrimsdottir L. Vitamin D - a systematic literature review for the 5th edition of the Nordic Nutrition Recommendations. Food Nutr Res 2013;57:22671.  
  30. Madsen KH, Rasmussen LB, Andersen R, Molgaard C, Jakobsen J, Bjerrum PJ, Andersen EW, Mejborn H, Tetens I. Randomized controlled trial of the effects of vitamin D-fortified milk and bread on serum 25-hydroxyvitamin D concentrations in families in Denmark during winter: the VitmaD study. Am J Clin Nutr 2013;98:374-82.  
  31. Gronborg IM, Tetens I, Christensen T, Andersen EW, Jakobsen J, Kiely M, Cashman KD, Andersen R. Vitamin D-fortified foods improve wintertime vitamin D status in women of Danish and Pakistani origin living in Denmark: a randomized controlled trial. Eur J Nutr 2020;59:741-53.   https://doi.org/10.1007/s00394-019-01941-6
  32. Cashman KD, Fitzgerald AP, Kiely M, Seamans KM. A systematic review and meta-regression analysis of the vitamin D intake-serum 25-hydroxyvitamin D relationship to inform European recommendations. Br J Nutr 2011;106:1638-48.  
  33. Kiely M, Cashman KD. Summary outcomes of the ODIN project on food fortification for vitamin D deficiency prevention. Int J Environ Res Public Health 2018;15:2342.  
  34. Cashman KD, Kiely M. Vitamin D and food fortification. In: Feldman D, editor. Vitamin D. Cambridge (MA): Academic Press; 2018. p.109-27. 
  35. Asakura K, Etoh N, Imamura H, Michikawa T, Nakamura T, Takeda Y, Mori S, Nishiwaki Y. Vitamin D status in Japanese adults: Relationship of serum 25-hydroxyvitamin D with simultaneously measured dietary vitamin D intake and ultraviolet ray exposure. Nutrients 2020;12:743.  
  36. Langlois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S. Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Health Rep 2010;21:47-55.  
  37. Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B. Regional variation and determinants of vitamin D status in sunshine-abundant Thailand. BMC Public Health 2011;11:853.  
  38. Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism. Boston (MA): Cengage Learning; 2012. 
  39. Nieves JW. Osteoporosis: the role of micronutrients. Am J Clin Nutr 2005;81:1232S-1239S.   https://doi.org/10.1093/ajcn/81.5.1232
  40. Spiro A, Buttriss JL, Vitamin D. Vitamin D: an overview of vitamin D status and intake in Europe. Nutr Bull 2014;39:322-50.  
  41. Laaksi IT, Ruohola JP, Ylikomi TJ, Auvinen A, Haataja RI, Pihlajamaki HK, Tuohimaa PJ. Vitamin D fortification as public health policy: significant improvement in vitamin D status in young Finnish men. Eur J Clin Nutr 2006;60:1035-8.   https://doi.org/10.1038/sj.ejcn.1602414
  42. Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009;169:551-61.   https://doi.org/10.1001/archinternmed.2008.600
  43. Ebeling PR, Eisman JA. Vitamin D and osteoporosis. In: Feldman D, editor. Vitamin D. Cambridge (MA): Academic Press; 2018. p.203-20. 
  44. Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 2003;77:504-11.   https://doi.org/10.1093/ajcn/77.2.504
  45. Polzonetti V, Pucciarelli S, Vincenzetti S, Polidori P. Dietary intake of vitamin d from dairy products reduces the risk of osteoporosis. Nutrients 2020;12:1743.  
  46. Ho-Pham LT, Nguyen ND, Nguyen TV. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr 2009;90:943-50.   https://doi.org/10.3945/ajcn.2009.27521
  47. Reid IR, Horne AM, Mihov B, Gamble GD, Al-Abuwsi F, Singh M, Taylor L, Fenwick S, Camargo CA, Stewart AW, et al. Effect of monthly high-dose vitamin D on bone density in community-dwelling older adults substudy of a randomized controlled trial. J Intern Med 2017;282:452-60.   https://doi.org/10.1111/joim.12651
  48. Joo NS, Dawson-Hughes B, Kim YS, Oh K, Yeum KJ. Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-3, 2009 and KNHANES V-1, 2010). J Bone Miner Res 2013;28:764-70.   https://doi.org/10.1002/jbmr.1790
  49. Kuiper JW, van Kuijk C, Grashuis JL, Ederveen AG, Schutte HE. Accuracy and the influence of marrow fat on quantitative CT and dual-energy X-ray absorptiometry measurements of the femoral neck in vitro. Osteoporos Int 1996;6:25-30.   https://doi.org/10.1007/BF01626534
  50. Blake GM, Griffith JF, Yeung DKW, Leung PC, Fogelman I. Effect of increasing vertebral marrow fat content on BMD measurement, T-score status and fracture risk prediction by DXA. Bone 2009;44:495-501.   https://doi.org/10.1016/j.bone.2008.11.003
  51. Griffith JF, Yeung DK, Antonio GE, Wong SY, Kwok TC, Woo J, Leung PC. Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation. Radiology 2006;241:831-8. https://doi.org/10.1148/radiol.2413051858