The aging process is often accompanied by increase in body weight. Older adults with overweight or obesity might have an overconsumption in energy that is accompanied by inadequate intake of protein, vitamin D, and calcium. It is unclear if intake of protein and vitamin D and calcium is sufficient in older adults with overweight/obesity, and whether it differs from older adults with normal weight, since a recent overview of the literature review is lacking. Therefore, we systematically analyzed the current evidence on differences in nutrient intake/status of protein, vitamin D and calcium between older adults with different body mass index (BMI) categories. Randomized controlled trials and prospective cohort studies were identified from PubMed and EMBASE. Studies reporting nutrient intake/status in older adults aged ≥50 years with overweight/obesity and studies comparing between overweight/obesity and normal weight were included. Nutrient intake/status baseline values were reviewed and when possible calculated for one BMI category (single-group meta-analysis), or compared between BMI categories (meta-analysis). Nutrient intake/status was compared with international recommendations. Mean protein (N = 8) and calcium intake (N = 5) was 0.98 gram/kilogram body weight/day (g/kg/d) [95% Confidence Interval (CI) 0.89–1.08] and 965 mg [95% CI: 704–1225] in overweight/obese. Vitamin D intake was insufficient in all BMI categories (N = 5). The pooled mean for vitamin D intake was 6 ug [95% CI 4–9]. For 25(OH)D, the pooled mean was 54 nmol/L [95% CI 45–62], 52 nmol/L [95% CI 46–58], and 48 nmol/l [95% CI 33–62] in normal (N = 7), combined overweight and obese (N = 12), and obese older adults (N = 4), respectively. In conclusion, older adults with overweight and obesity have a borderline sufficient protein and sufficient calcium intake, but insufficient vitamin D intake. The 25(OH)D concentration is deficient for the obese older adults.
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The purpose of these systematic review and meta-analysis was to assess the effectiveness of dairy components on nutritional status and physical fitness in older adults, as evidence for efficacy of the supplementation of these components is inconclusive. Scopus and MEDLINE were searched. Main inclusion criteria for articles were as follows: double-blind, randomized, placebo-controlled trials including participants aged ≥55 years who received dairy components or a placebo. Outcome measures were nutrient status (body weight and body mass index) and physical fitness (body composition, muscle strength, and physical performance). Thirty-six trials with 4947participants were included. Most trials investigated protein and vitamin D supplementation and showed no effect on the outcomes. Meta-analysis on the effect of protein on body weight showed a significant increase in mean difference of 1.13 kg (95% confidence interval, 0.59-1.67). This effect increased by selecting trials with study a duration of 6 months in which less nourished and physically fit participants were included. Trials where the participants were (pre-)frail, inactive older adults or when supplementing ≥20 g of protein per day tended to increase lean body mass. Only small significant effects of vitamin D supplementation on Timed Up and Go (mean difference -0.75 seconds; 95% confidence interval -1.44 to -0.07) were determined. This effect increased when vitamin D doses ranged between 400 and 1000 IU. Additional large randomized controlled trials of ≥6 months are needed regarding the effect of dairy components containing an adequate amount of vitamin D (400-1000 IU) and/or protein (≥20 g) on nutritional status and physical fitness in malnourished or frail older adults.
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Studies monitoring vitamin D status in athletes are seldom conducted for a period of 12 months or longer, thereby lacking insight into seasonal fluctuations. The objective of the cur-rent study was to identify seasonal changes in total 25-hydroxyvitamin D (25(OH)D) concen-tration throughout the year. Fifty-two, mainly Caucasian athletes with a sufficient 25(OH)D concentration (>75 nmol/L) in June were included in this study. Serum 25(OH)D concentra-tion was measured every three months (June, September, December, March, June). Addition-ally, vitamin D intake and sun exposure were assessed by questionnaires at the same time points. Highest total 25(OH)D concentrations were found at the end of summer (113±26 nmol/L), whereas lowest concentrations were observed at the end of winter (78±30 nmol/L). Although all athletes had a sufficient 25(OH)D concentration at the start of the study, nearly 20% of the athletes were deficient (<50 nmol/L) in late winter.
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Background: A chronic low-grade infammatory profle (CLIP) is associated with sarcopenia in older adults. Protein and Vitamin (Vit)D have immune-modulatory potential, but evidence for efects of nutritional supplementation on CLIP is limited. Aim To investigate whether 13 weeks of nutritional supplementation of VitD and leucine-enriched whey protein afected CLIP in subjects enrolled in the PROVIDE-study, as a secondary analysis. Methods: Sarcopenic adults (low skeletal muscle mass) aged ≥ 65 years with mobility limitations (Short Physical Performance Battery 4–9) and a body mass index of 20–30 kg/m2 were randomly allocated to two daily servings of active (n=137, including 20 g of whey protein, 3 g of leucine and 800 IU VitD) or isocaloric control product (n=151) for a double-blind period of 13 weeks. At baseline and after 13 weeks, circulating interleukin (IL)-8, IL-1 receptor antagonist (RA), soluble tumor-necrosis-factor receptor (sTNFR)1, IL-6, high-sensitivity C-reactive protein, pre-albumin and 25-hydroxyvitamin(OH) D were measured. Data-analysis included repeated measures analysis of covariance (corrected for dietary VitD intake) and linear regression. Results: IL-6 and IL-1Ra serum levels showed overall increases after 13 weeks (p=0.006 and p<0.001, respectively). For IL-6 a signifcant time × treatment interaction (p=0.046) was observed, with no signifcant change over time in the active group (p=0.155) compared to control (signifcant increase p=0.012). IL-8 showed an overall signifcant decrease (p=0.03). The change in pre-albumin was a signifcant predictor for changes in IL-6 after 13 weeks. Conclusions: We conclude that 13 weeks of nutritional supplementation with VitD and leucine-enriched whey protein may attenuate the progression of CLIP in older sarcopenic persons with mobility limitations
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Inleiding Het doel van dit onderzoek was inzicht te krijgen in het gebruik van vitamine D-suppletie onder thuiswonende 70-plussers en dit te vergelijken met de vitamine D-suppletie uit de Voedselconsumptiepeiling 2010-2012 onder 70-plussers (VCP 70+). Als secundaire vraagstelling werd onderzocht of er een samenhang bestaat tussen kwetsbaarheid en het opvolgen van het vitamine D-suppletieadvies. Methode Dit onderzoek werd uitgevoerd als een substudie van een gerandomiseerde interventiestudie, het Consu-MEER-onderzoek. Voor deze substudie werden de nulmetingen van 94 thuiswonende 70-plussers gebruikt. Het gebruik van supplementen die vitamine D bevatten werd nagevraagd en gecategoriseerd als ‘voldoende’ (≥20 μg/dag), ‘onvoldoende’ (<20 μg/dag) of ‘niet’. Kwetsbaarheid werd beoordeeld op basis van de Fried frailty criteria. Een deelnemer werd gecategoriseerd als ‘kwetsbaar’ wanneer 3 van de criteria van toepassing waren, en als ‘pre-kwetsbaar’ wanneer 1 of 2 van de criteria van toepassing waren. Eventuele verschillen met de gerapporteerde vitamine D-suppletie uit de VCP 70+ werden getoetst met binomiale toetsen. De Fisher’s exact test werd gebruikt om de samenhang tussen vitamine D-suppletie en kwetsbaarheid te toetsen. Resultaten Het percentage thuiswonende ouderen (gemiddelde leeftijd 80,8 jaar, 61,7% vrouw) dat zich hield aan het vitamine D-suppletieadvies was 51% (mannen 44,4%, vrouwen 55,2%). Dit was significant hoger dan de suppletie onder de VCP-populatie (23%, p<0,001). Zeven deelnemers werden gecategoriseerd als ‘kwetsbaar’, 42 als ‘pre-kwetsbaar’. Er was geen verschil in suppletie conform advies tussen de drie kwetsbaarheidscategorieën (p=0,387). Conclusie Dit onderzoek laat zien dat het vitamine D-suppletieadvies voor ouderen van 70 jaar en ouder van de Gezondheidsraad nog steeds onvoldoende wordt opgevolgd, ook door meer kwetsbare thuiswonende ouderen. Blijvende aandacht voor adequate suppletie blijft noodzakelijk. Tevens wordt aanbevolen om ook de meer kwetsbare groep mee te nemen in de komende VCP.
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Background Exercise therapy is the cornerstone of knee osteoarthritis (OA) management. In particular muscle strengthening exercise, targeting the characteristic loss of muscle strength present in knee OA, is a key factor for the beneficial effects reported for exercise therapy. The optimal training intensity for resistance training in patients with knee OA, however, is not known to date. Besides resistance training, vitamin D supplementation in patients with vitamin deficiency may optimize muscle strength. Objectives To assess (i) whether high-intensity resistance training leads to greater improvements in muscle strength compared to moderate-intensity resistance training in patients with knee OA; and (ii) whether vitamin D supplementation in combination with strength training leads to greater improvements in muscle strength compared to placebo in combination with strength training in patients with knee OA and vitamin D deficiency (25 (OH)D level > 15 nmol/L and < 50 nmol/L (in winter) or <70 nmol/L (in summer)). Methods In a randomized controlled trial, 177 patients with a clinical diagnosis of knee OA were included. All patients were randomly allocated to a high-intensity (70-80% of the Repetition Maximum (1RM)) or a moderate-intensity (40-50% of the 1RM) resistance training program of 12 weeks. Both groups were supervised by a physical therapist twice a week and performed home exercises once a week. In addition, 50 out 177 patients had vitamin D deficiency and received supplementation of vitamin D (1200 IU vitamin D3 per day) or placebo in the 12 weeks prior to and during the resistance training program. The primary outcome measure was isokinetic (60 °/s) upper leg muscle strength (Nm/kg). In addition, the estimated 1 RM for leg press, leg curl and hip abduction were used as measures for muscle strength. Other outcome measures included severity of knee pain (NRS), self-reported and performance based activity limitations (WOMAC physical functioning (WOMAC), Get-up-and-go-test (GUG)). Measurements were performed by a blinded assessor prior to the exercise program (T0), directly after the program (T12) and at 6 months follow-up (T36). Additionally, for patients with vitamin D deficiency, measurements were also taken prior to vitamin supplementation or placebo (T-12). Results Both the high-intensity group and moderate-intensity group improved in upper leg muscle strength over time. No significant differences between groups were found for isokinetic upper leg muscle strength (p = 0.646) (see figure 1). However, when measured by the estimated 1 RM, significant differences were found between groups in favor of the high–intensity group (p = 0.001) (see figure 1). No between-group differences were found on pain (p = 0.885), or on self-reported and performance-based activity limitations (WOMAC p = 0.968; GUG p = 0.800), although both groups improved (see figure 1). An unexpected finding was that, in the (small sample of) patients with vitamin D deficiency, the placebo group showed significant greater isokinetic upper leg muscle strength over time compared to the vitamin D group (p = 0.001). Conclusion No differences between groups were found for isokinetic upper leg muscle strength. With the estimated 1 RM as a measure of muscle strength, high-intensity resistance training led to greater improvements in muscle strength compared to moderate-intensity resistance training in patients with knee OA. This did not result in greater improvements in pain and physical functioning in the high-intensity resistance group; both groups showed similar clinically important improvements. The added value of vitamin D supplementation on muscle strength in knee OA patients with vitamin D deficiency need further study.
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BACKGROUND: Intentional weight loss in obese older adults is a risk factor for muscle loss and sarcopenia.OBJECTIVE: The objective was to examine the effect of a high whey protein-, leucine-, and vitamin D-enriched supplement on muscle mass preservation during intentional weight loss in obese older adults.DESIGN: We included 80 obese older adults in a double-blind randomized controlled trial. During a 13-wk weight loss program, all subjects followed a hypocaloric diet (-600 kcal/d) and performed resistance training 3×/wk. Subjects were randomly allocated to a high whey protein-, leucine-, and vitamin D-enriched supplement including a mix of other macro- and micronutrients (150 kcal, 21 g protein; 10×/wk, intervention group) or an isocaloric control. The primary outcome was change in appendicular muscle mass. The secondary outcomes were body composition, handgrip strength, and physical performance. Data were analyzed by using ANCOVA and mixed linear models with sex and baseline value as covariates.RESULTS: At baseline, mean ± SD age was 63 ± 5.6 y, and body mass index (in kg/m(2)) was 33 ± 4.4. During the trial, protein intake was 1.11 ± 0.28 g · kg body weight(-1) · d(-1) in the intervention group compared with 0.85 ± 0.24 g · kg body weight(-1) · d(-1) in the control group (P < 0.001). Both intervention and control groups decreased in body weight (-3.4 ± 3.6 kg and -2.8 ± 2.8 kg; both P < 0.001) and fat mass (-3.2 ± 3.1 kg and -2.5 ± 2.4 kg; both P < 0.001), with no differences between groups. The 13-wk change in appendicular muscle mass, however, was different in the intervention and control groups [+0.4 ± 1.2 kg and -0.5 ± 2.1 kg, respectively; β = 0.95 kg (95% CI: 0.09, 1.81); P = 0.03]. Muscle strength and function improved over time without significant differences between groups.CONCLUSION: A high whey protein-, leucine-, and vitamin D-enriched supplement compared with isocaloric control preserves appendicular muscle mass in obese older adults during a hypocaloric diet and resistance exercise program and might therefore reduce the risk of sarcopenia. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl) as NTR2751.
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BACKGROUND & AIMS: Oral supplementation with vitamin D is recommended for older adults to maintain a sufficient 25-hydroxyvitamin D (25(OH)D) status throughout the year. While supplementation with vitamin D2 or D3 is most common, alternative treatment regimens exist which require further investigation with respect to increasing 25(OH)D concentration. We investigated the dose-response effects of supplementation with calcifediol compared to vitamin D3 and assessed the dose which results in mean serum 25(OH)D3 concentrations between 75 and 100 nmol/L.METHODS: This randomized, double-blind intervention study included men and women aged ≥65 years (n = 59). Participants received either 5, 10 or 15 μg calcifediol or 20 μg vitamin D3 per day, for a period of 24 weeks. Blood samples were collected every four weeks to assess response profiles of vitamin D related metabolites; serum vitamin D3, 25(OH)D3, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3). Further, serum calcium, plasma parathyroid hormone, and urinary calcium were evaluated.RESULTS: Supplementation with 20 μg vitamin D3 increased 25(OH)D3 concentrations towards 70 nmol/L within 16 weeks. Supplementation with 10 or 15 μg calcifediol increased 25(OH)D3 levels >75 nmol/L in 8 and 4 weeks, respectively. Steady state was achieved from week 12 onwards with serum 25(OH)D3 levels stabilizing between 84 and 89 nmol/L in the 10 μg calcifediol group. A significant association was observed between the changes in 25(OH)D3 and 24,25(OH)2D3 (R2 = 0.83, P < 0.01), but not between 25(OH)D3 and 1,25(OH)2D3 (R2 = 0.04, P = 0.18). No cases of hypercalcemia occurred in any treatment during the study period.CONCLUSIONS: Calcifediol supplementation rapidly and safely elevates serum 25(OH)D3 concentrations to improve vitamin D status in older adults. A daily dose of 10 μg calcifediol allows serum 25(OH)D3 concentrations to be maintained between 75 and 100 nmol/L.TRIAL REGISTRATION NUMBER: NCT01868945.
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Diet related non-communicable diseases (NCDs), as well as micronutrient deficiencies, are of widespread and growing importance to public health. Authorities are developing programs to improve nutrient intakes via foods. To estimate the potential health andeconomic impact of these programs there is a wide variety of models. The aim of this review is to evaluate existing models to estimate the health and/or economic impact of nutrition interventions with a focus on reducing salt and sugar intake andincreasing vitamin D, iron, and folate/folic acid intake. The protocol of this systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016050873). The final search was conducted onPubMed and Scopus electronic databases and search strings were developed for salt/sodium, sugar, vitamin D, iron, and folic acid intake. Predefined criteria related to scientific quality, applicability, and funding/interest were used to evaluate the publications. In total 122 publications were included for a critical appraisal: 45 for salt/sodium, 61 for sugar, 4 for vitamin D, 9 for folic acid, and 3 for iron. The complexity of modelling the health and economic impact of nutrition interventions is dependent on the purpose and data availability. Although most of the models have the potential to provide projections of future impact, the methodological challenges are considerable. There is a substantial need for more guidance and standardization for future modelling, to compare results ofdifferent studies and draw conclusions about the health and economic impact of nutrition interventions.
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BACKGROUND. In order to prevent sarcopenia in community dwelling older adults a higher daily protein intake is needed. A new m-health strategy for dietary counseling was used with the aim to increase total daily protein intake to optimal levels (minimal 1.2 g/kg/d, optimal 1.5 g/kg/d) through use of regular food products. METHODS. The VITAMIN (VITal AMsterdam older adults IN the city) RCT included 245 community dwelling older adults (age ≥ 55y): control, exercise, and exercise plus dietary counseling (protein) group. Dietary intake was measured by a 3d dietary record at baseline and after 6 months intervention. In total 173 subjects were eligible for analysis. A two-way mixed ANOVA with time, group, and time*group interaction was performed. Post-hoc Bonferroni was performed with significance level at p<0.05. RESULTS. Mean age of the subjects was 72.1±6.3y, with a BMI of 25.7±4.2 of which 68% were females. ANOVA revealed significant effect of time, group and time*group (p<0.001). Table 1 shows higher protein intake over time in the dietary counseling group than either control (p=0.038) or exercise (p=0.008) group. Additional analyses revealed no change in vegetable protein intake. The higher protein intake was fully accounted for by animal protein intake. In the dietary counseling group 72% of subjects increased protein intake above the minimum intake level.
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