Amanda Devine

Effects of Ergocalciferol Added to Calcium on the Risk of Falls in Elderly High-Risk Women

BACKGROUND Ergocalciferol (vitamin D(2)) supplementation plays a role in fall prevention, but the effect in patients living in the community in sunny climates remains uncertain. We evaluated the effect of ergocalciferol and calcium citrate supplementation compared with calcium alone on the risk of falls in older women at high risk of falling. METHODS A 1-year population-based, double-blind, randomized controlled trial of 302 community-dwelling ambulant older women aged 70 to 90 years living in Perth, Australia (latitude, 32 degrees S), with a serum 25-hydroxyvitamin D concentration of less than 24.0 ng/mL and a history of falling in the previous year. Participants were randomized to receive ergocalciferol, 1000 IU/d, or identical placebo (hereinafter, ergocalciferol and control groups, respectively). Both groups received calcium citrate, 1000 mg/d. Fall data were collected every 6 weeks. RESULTS Ergocalciferol therapy reduced the risk of having at least 1 fall over 1 year after adjustment for baseline height, which was significantly different between the 2 groups (ergocalciferol group, 53.0%; control group, 62.9%; odds ratio [OR], 0.61; 95% confidence interval [CI], 0.37-0.99). When those who fell were grouped by the season of first fall or the number of falls they had, ergocalciferol treatment reduced the risk of having the first fall in winter and spring (ergocalciferol group, 25.2%; control group, 35.8%; OR, 0.55; 95% CI, 0.32-0.96) but not in summer and autumn, and reduced the risk of having 1 fall (ergocalciferol group, 21.2%; control group, 33.8%; OR, 0.50; 95% CI, 0.28-0.88) but not multiple falls. CONCLUSION Patients with a history of falling and vitamin D insufficiency living in sunny climates benefit from ergocalciferol supplementation in addition to calcium, which is associated with a 19% reduction in the relative risk of falling, mostly in winter.

Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors.

OBJECTIVES: To determine longitudinal predictors of incident and persistent fear of falling (FOF) in older women.

A Randomized Controlled Trial of the Effects of Vitamin D on Muscle Strength and Mobility in Older Women with Vitamin D Insufficiency

OBJECTIVES: To evaluate the effects of vitamin D treatment on muscle strength and mobility in older women with vitamin D insufficiency.

Physical Activity and Calcium Consumption Are Important Determinants of Lower Limb Bone Mass in Older Women

A population‐based study of 1363 older women showed that the 24% who achieved high physical activity and dietary calcium intakes had a 5.1% higher hip BMD than those who did not, supporting the concept that lifestyle factors play an important role in the maintenance of lower extremity bone mass in older women.

Randomized Controlled Trial of the Effects of Calcium With or Without Vitamin D on Bone Structure and Bone‐Related Chemistry in Elderly Women With Vitamin D Insufficiency

There are few data on the relative effects of calcium supplementation with or without extra vitamin D on BMD in patients selected for low vitamin D status. The aim of this study is to evaluate the relative importance of vitamin D and calcium treatment on BMD and bone‐related chemistry in elderly women with vitamin D insufficiency. Three hundred two elderly women (age, 77.2 ± 4.6 yr) with serum 25(OH)D concentrations <60 nM participated in a 1‐yr randomized, double‐blind, placebo‐controlled trial. All subjects received 1000 mg calcium citrate per day with either 1000 IU ergocalciferol (vitamin D2) or identical placebo (control). The effects of time and time treatment interactions were evaluated by repeated‐measures ANOVA. At baseline, calcium intake was 1100 mg/d, and 25(OH)D was 44.3 ± 12.9 nM; this increased in the vitamin D group by 34% but not the control group after 1 year (59.8 ± 13.8 versus 45.0 ± 13.3 nM, p < 0.001). Total hip and total body BMD increased significantly, and procollagen type I intact N‐terminal propeptide (PINP) decreased during the study with no difference between the treatment groups (hip BMD change: vitamin D, +0.5%; control, +0.2%; total body BMD change: vitamin D, +0.4%; control, +0.4%; PINP change: vitamin D, −3.9%; placebo, −2.8%). Although the fasting plasma and urine calcium increased in both groups equally, there was no detectable change in serum PTH. The increase in 25(OH)D achieved with vitamin D supplementation had no extra effect on active fractional intestinal calcium absorption, which fell equally in both groups (vitamin D, −17.4%; control, −14.8%). In patients with a baseline calcium intake of 1100 mg/d and vitamin D insufficiency, vitamin D2 1000 IU for 1 year has no extra beneficial effect on bone structure, bone formation markers, or intestinal calcium absorption over an additional 1000 mg of calcium. Vitamin D supplementation adds no extra short‐term skeletal benefit to calcium citrate supplementation even in women with vitamin D insufficiency.

A 5-year cohort study of the effects of high protein intake on lean mass and BMC in elderly postmenopausal women

Long‐term effects of high dietary protein intake on muscle and bone structure in the elderly are not clear. The aim of this study was to investigate the relationship between baseline protein intake and lean mass and BMC 5 yr later in a cohort of elderly postmenopausal women. A total of 862 community‐dwelling women 75 ± 3 yr of age provided baseline data including nutrient intake assessed by a food frequency questionnaire. At 5 yr, upper arm muscle area (UAMA) and body composition using DXA were measured. Baseline protein intake was 81 ± 28 g/d (1.2 ± 0.4 g/kg/d), contributing 19 ± 3% of total energy intake. There were positive correlations between baseline protein intake and whole body and appendicular bone‐free lean mass and BMC (r = 0.14–0.18, p < 0.001) and UAMA (r = 0.08, p < 0.05). Compared with those in the lowest tertile of protein intake (<66 g/d), women in the top tertile (>87 g/d) had 5.4–6.0% higher whole body and appendicular lean mass and UAMA and 5.3–6.0% higher whole body and appendicular BMC. These effects remained after adjusting for potential confounders. However, the effect on BMC disappeared after further adjustment for lean mass. This study shows that high protein intake is associated with long‐term beneficial effects on muscle mass and size and bone mass in elderly women. The protein effect on bone may be partly mediated by its effects on muscle.

Phenolic acid metabolites as biomarkers for tea- and coffee-derived polyphenol exposure in human subjects

Tea and coffee are rich in polyphenols with a variety of biological activities. Many of the demonstrated activities are consistent with favourable effects on the risk of chronic diseases. 4-O-methylgallic acid (4OMGA) and isoferulic acid are potential biomarkers of exposure to polyphenols derived from tea and coffee respectively. 4OMGA is derived from gallic acid in tea, and isoferulic acid is derived from chlorogenic acid in coffee. Our major objective was to explore the relationships of tea and coffee intake with 24 h urinary excretion of 4OMGA and isoferulic acid in human subjects. The relationships of long-term usual (111 participants) and contemporaneously recorded current (344 participants) tea and coffee intake with 24 h urinary excretion of 4OMGA and isoferulic acid were assessed in two populations. 4OMGA was related to usual (r 0.50, P<0.001) and current (r 0.57, P<0.001) tea intake, and isoferulic acid was related to usual (r 0.26, P=0.008) and current (r 0.18, P<0.001) coffee intake. Overall, our present results are consistent with the proposal that 4OMGA is a good biomarker for black tea-derived polyphenol exposure, but isoferulic acid may be of limited usefulness as a biomarker for coffee-derived polyphenol exposure.

Association of Back Pain Frequency With Mortality, Coronary Heart Events, Mobility, and Quality of Life in Elderly Women

Study Design. A 5-year observational cohort design using data from a randomized controlled trial of calcium intervention. Objective. To describe the epidemiology of back pain and determine the association of back pain frequency to mortality, coronary heart events, mobility, and quality of life in elderly women. Summary of Background Data. Although back pain is a common physical symptom in the elderly, little is known of its effects and long-term outcomes. Methods. The study subjects were 1484 community dwelling Australian women 70 to 85 years of age. At baseline and 5 years, back pain frequency was assessed by self-report, mobility by the Timed Up and Go Test (TUAG) and Quality of Life by the SF-36 questionnaire. The all cause of death data were ascertained from death certificates available for all deaths over 5 years, and incident clinical coronary heart disease (CHD) data were adjudicated from patient diaries verified by primary care physician and medication records. Results. At baseline and 5 years, 21.7% and 26.9% subjects experienced daily back pain (≥1/day) and 27.6% and 24.4% subjects experienced frequent back pain (1/mo to 1/day), respectively. Compared with those with infrequent (<1/mo) back pain, subjects with daily back pain had significantly lower quality of life physical component score and mobility as assessed by TUAG at both baseline and 5 years. Daily back was associated with greater overall mortality risk (hazards ratio = 2.03; 95% confidence interval, 1.14–3.60) and greater risk of CHD mortality and new CHD diagnosis (hazards ratio = 2.13; 95% CI, 1.35–3.34) after adjusted for baseline age. The effects remained significant after further adjustment for cardiovascular risk factors and physical activity level. Conclusion. Daily back pain is associated with reduced quality of life, mobility and longevity and increased risk of coronary heart events. The adverse health effects of chronic back pain deserve greater recognition.

Do sleep problems or urinary incontinence predict falls in elderly women

The objectives of this cross-sectional study were: (1) To determine if night-time sleep disturbance, daytime sleepiness, or urinary incontinence were associated with an increased risk of falling in older Australian women and (2) to explore the interrelationships between daytime sleepiness, night-time sleep problems, and urge incontinence. Participants were 782 ambulatory, community-dwelling women aged 75 to 86 recruited from within the existing Calcium Intake Fracture Outcome Study, in which women above 70 years were selected at random from the electoral roll. Daytime sleepiness, night-time sleep problems, urinary incontinence and falls data were collected via self-complete questionnaires. Thirty-five per cent of participants had fallen at least once in the past 12 months and 37.7% reported at least one night-time sleep problem. However, only 8.1% of the study sample experienced abnormal daytime sleepiness (Epworth Sleepiness Scale score > 10). Pure stress, pure urge, and mixed incontinence occurred in 36.8%, 3.7%, and 32.6% of participants respectively. In forward stepwise multiple logistic regression analysis, urge incontinence (OR 1.76; 95% CI 1.29 to 2.41) and abnormal daytime sleepiness (OR 2.05; 95% CI 1.21 to 3.49) were significant independent risk factors for falling after controlling for other falls risk factors (age, central nervous system drugs, cardiovascular drugs). As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.

Differences in satiety effects of alginate- and whey protein-based foods

Satiety is important in regulating food intake and has important public health significance in the control of obesity. Food containing protein and non-starch polysaccharides provides a satiety effect through various mechanisms but a comparison of the satiety effect on each has not previously been investigated. This study compared the satiety effect or reduction of hunger after consumption of (i) a whey protein-based drink versus an alginate-based drink of the same viscosity where only the protein content differed, (ii) two alginate-based drinks differing in alginate type and viscosity, and (iii) a whey protein-based drink versus an alginate-based drink differing in protein content and viscosity. Fasted subjects assessed the effect of a drink on hunger that was one of three variants: a low viscosity whey protein drink (LVHP); a high viscosity low protein alginate-based drink (HVLP); or a low viscosity low protein alginate-based drink (LVLP) over the 240 min postprandial period using a Visual Analogue Scale (VAS). When protein differed and viscosity was the same, results showed subjects felt significantly less hungry after consuming the LVHP drink compared to the LVLP drink, so protein reduced hunger. Subjects reported reduced hunger from the HVLP drink compared to the LVLP drink where viscosity of drinks differed, suggesting viscosity and/or gelation reduced hunger. Subjects reported reduced hunger from the HVLP drink compared to LVHP drink where both protein and viscosity differed, suggesting that viscosity reduced hunger more than the protein effect. Results suggest the physical characteristics such as viscosity and/or gel strength and protein content reduce hunger. Further studies should investigate which of these parameters is more important.