Eilbhlís M. O'Connor

Serum percentage undercarboxylated osteocalcin, a sensitive measure of vitamin K status, and its relationship to bone health indices in Danish girls

Recent cross-sectional data suggest that better vitamin K status in young girls (aged 3-16 years) is associated with decreased bone turnover, even though it is not associated with bone mineral content (BMC). The objective of the present study was to investigate the relationship between serum percentage of undercarboxylated osteocalcin (%ucOC), as an index of vitamin K status, and BMC and biochemical indices of bone turnover in peri-pubertal Danish girls. This peri-pubertal stage is a dynamic period of bone development, and as such, may represent an important window of opportunity for vitamin K status to modulate childhood bone health. Serum %ucOC and serum 25-hydroxyvitamin D (25 (OH) D) were measured at baseline in a study of 223 healthy girls aged 11-12 years. Urinary pyridinium crosslinks of collagen and serum total osteocalcin as markers of bone resorption and formation, respectively, as well as BMC (total body and lumbar spine) were also measured. Serum %ucOC (median 21.9 %) was not associated with markers of bone resorption or with total osteocalcin. Serum %ucOC was inversely correlated with serum 25 (OH) D (r - 0.143; P < 0.05). Serum %ucOC was negatively associated with BMC of the total body (beta - 0.045; P < 0.001) and lumbar spine (beta - 0.055; P < 0.05), after adjustment for potential confounders including vitamin D status. Better vitamin K status was associated with increased BMC, but not bone turnover, in healthy peri-pubertal Danish girls. There is a need for well-designed, randomized phylloquinone supplementation trials in children and adolescents to confirm epidemiological findings of an association between vitamin K status and bone health.

Vitamin D-vitamin K interaction: effect of vitamin D supplementation on serum percentage undercarboxylated osteocalcin, a sensitive measure of vitamin K status, in Danish girls

There is some evidence for a nutritional interaction between vitamin D and vitamin K status. We have recently reported that serum percentage undercarboxylated osteocalcin (%ucOC; a marker of vitamin K status) was inversely correlated with serum 25-hydroxyvitamin D (25(OH)D) concentration (reflective of vitamin D status) in healthy Danish girls (aged 11-12 years), in line with a similar relationship reported in elderly women. While the causal nature of the relationship between vitamin D status and serum %ucOC has been tested in studies of elderly women, it has not been investigated in children. The objective of the present study was to test the hypothesis that improving vitamin D status significantly lowers serum %ucOC. Serum samples from sixty-seven healthy Danish girls (aged 11-12 years), who participated in a 12-month double-blind, placebo-controlled, vitamin D3 intervention trial were used for the present study. These girls were a subset of subjects which began and finished the intervention during wintertime, thus avoiding the influence of seasonality on vitamin D status. A total of thirty-three and thirty-four of the girls had been randomised to treatment with 10 μg vitamin D3 per d and placebo, respectively, for 12 months. Total osteocalcin and the fraction of ucOC in serum (via enzyme-immunoassay) as well as serum 25(OH)D (via HPLC) were assessed at baseline and end-point. Vitamin D3 supplementation significantly increased serum 25(OH)D (21.6 %; P < 0.002) but had no effect on serum %ucOC (P>0.8). In conclusion, the findings of the present intervention study in young girls suggest that vitamin D supplementation does not affect serum %ucOC, a marker of vitamin K status.

Gender differences in food intake among Irish community-dwelling elderly subjects: The ELDERMET project

The proportion of citizens older than 65 years of age in Western populations is increasing. It is therefore important to investigate the fundamental role of diet in the prevention of age-associated chronic disease. In addition, gender differences in food consumption and nutrient intakes are well recognised, and need to be further explored and addressed. The aim of this study was to establish the frequency of consumption of the major food groups within a cohort of elderly, Irish subjects (n = 210; 113 male and 97 female 64–93 y), who participated in the ELDERMET project. Dietary data was collected using a validated semi-quantitative, 147-item food frequency questionnaire (FFQ). Individual food and beverage items were aggregated into 30 (mutually exclusive) food groups. Median daily serving intake was calculated and statistical analysis was conducted using PASW2 (version 18.0) for two age categories, 64–75 yrs and ‡ 76 yrs. Females (64–75y) consumed significantly (P<0.05) more unrefined wholegrain cereals, dietary supplements, salad dressings, probiotic yoghurts, fresh soups, fish, hot beverages and fruit than males. Males of the same age range consumed significantly (P<0.05) more processed soups, meat products, soft drinks, alcohol, meat and refined cereals (see table). Cross-gender, food group variance among the more senior group (n = 102) was limited to alcohol intake; with males consuming significantly more than females (P<0.05). In addition, females from both age groups showed higher compliance rates with the recently revised Irish dietary guidelines for adults aged >51 y.

Fish-oil consumption is inversely correlated with depression and cognition decline in healthy Irish elderly adults

Epidemiological studies investigating associations between diet and cognitive function suggest a protective role for fish and fish-oil consumption in cognitive decline and depression, particularly among elderly populations. As longevity increases and elderly subjects become an increasing proportion of populations worldwide, it is important to establish dietary components associated with healthy brain aging. The aim of this study was to evaluate fish and fish-oil consumption in a sample of healthy, community-dwelling Irish adults and to explore the association between fish and fish oil consumption, and cognitive function and depression score. Fish and fish product intakes, cognitive function and depressive symptoms were assessed among community-dwelling, elderly adults (n = 172; age 64–93 yrs) who participated in the ELDERMET project. Fish and fish product consumption was evaluated using a 147-item, validated, semi-quantitative Food Frequency Questionnaire, where fish intakes were categorized into the following groups; processed/fried fish, white fish, oily fish, shellfish and fish-oil supplements. The Mini Mental State Exam (MMSE) and Geriatric Depression Scale (GDS) were used to determine cognitive function and depressive symptoms, respectively. Among the fish and fish-products assessed, white fish was consumed most frequently, by 84% of the group, with 72% of consumers complying with recommended intakes of one or more servings of white fish/wk. Seventy-six percent of the group consumed oily fish with 64% complying with recommendations. Shellfish consumption was lowest at 31%. Consumption and compliance to recommended intakes was highest among females for all fish and fish-products, except for processed/fried fish consumption, which was higher among males. Fish-oils were consumed by 19% of the group, of which 55% were female. No significant correlation was observed between white fish consumption and GDS (Pearson correlation coefficient r = 0.007; P = 0.97) and MMSE (r = 0.007; P = 0.928). Similarly for oily fish, there was no association between GDS (r = 0.072; P = 0.427) and MMSE> (r = 0.052; P = 0.497), indicating no positive effect of either white or oily fish consumption on improved depressive symptoms or cognitive function. However, an inverse association was found between fish-oil supplement consumption and GDS (r = 0.229; P = 0.010); suggesting an association between reduced depressive symptoms and increased fish-oil consumption. In addition, a trend for association between fish-oil consumption with MMSE (r = 0.145; P = 0.057) was also observed, whereby increasing fish-oil consumption was associated with a trend for improved cognitive function. In conclusion, fish consumption was comparable with a nationally representative sample of healthy, elderly Irish individuals. However gender differences indicate better compliance with guidelines among females. Further studies investigating the effect of fish-oil consumption on cognitive function and depressive symptoms in elderly groups are warranted. Fish consumption should be promoted in the elderly as it may prevent brain ageing processes and reduce cognitive decline.

Gender differences in folate status are associated with cognition in healthy Irish elderly adults

In elderly populations, cognitive impairment and incident dementia may be related to inadequate vitamin B status, predominantly folate and vitamin B12. Folate deficiency has been associated with Alzheimer’s disease as well as preceding the onset of other dementia , while low folate and vitamin B12 have been associated with depressive symptoms . Functional deterioration may also increase with folate deficiency. The aim of this study was to examine associations between B vitamins (serum folate and vitamin B12) and measures of cognition in a sample of healthy Irish adults. Serum vitamin B12 and folate concentrations were measured by ELISA in 194 community-dwelling and day hospital patients (aged 64–95 years) who participated in the ELDERMET project. Cognitive and functional evaluation included the Mini Mental State Exam (MMSE) and Barthel Index of Activities of Daily Living, while the Geriatric Depression scale was used as a screening tool for depression.

Compliance with Irish food-based dietary guidelines in elderly subjects recruited from rehabilitation wards and out-patient clinics in Southern region hospitals (The ELDERMET project)

The elderly population are an “at-risk” group for under-nutrition which is associated with longer duration in hospitalised care as well as increased prevalence of morbidity and mortality. Identifying food consumption patterns and the contribution of the main food groups to nutritional status is essential to identify those at risk of underor over-nutrition. The aim of this study was to establish the frequency of consumption of the major food groups in two groups of elderly Irish subjects, who participated in the ELDERMET project, and to explore their compliance with the recently revised Irish food based dietary recommendations. Subjects were recruited from rehabilitation wards (n 62; aged 65–93 y) and out-patient clinics (n 45; aged 67–92 y) in two Southern region hospitals. Dietary data was collected using a validated semi-quantitative, food frequency questionnaire (FFQ). Daily food group consumption was estimated and compared to Irish food-based dietary guidelines. Over 82% of rehab and out-patient subjects complied with the recommended number of servings for breads, cereals and potatoes. In addition, both groups consumed adequate fruit and vegetables (see Table) with 51.6% of rehab and 53.3% of out-patient subjects meeting recommendations to consume 5+ servings per day. However, poor compliance was evident for dairy-rich foods with only 14.5% of rehab and 4.4% of out-patient subjects meeting recommendations. Compliance with recommendations for low-nutrient dense foods, high in fat and/or sugar for rehab and out-patients was also particularly low in both groups at 6.5% and 13.3%, respectively. In addition, 53.2% of rehab and 66.7% of out-patient subjects were classified as overweight or obese according to Body Mass Index (BMI). This high rate of overweight and obesity is in line with general healthy population trends.

Consumption of fruit and vegetables among elderly Irish people in long-term institutionalised care: the ELDERMET project

Fruit and vegetables are an important source of vitamins and minerals such as vitamin C, folate, K and b-carotene . High fruit and vegetable consumption may reduce the risk of several chronic diseases, including cancers, CVD, hypertension and stroke. The benefits of fruit and vegetable consumption continue into old age. In fact, with advancing age the requirements for some antioxidants may be increased. The Irish food-based dietary guidelines therefore recommends consumption of at least five portions of fruit and vegetables daily. The aim of this study was to establish the frequency of consumption of fruit and vegetables within a sample of institutionalised elderly, Irish subjects (n 99; twenty-six men and seventy-three women; aged 66–104 years), who participated in the ELDERMET project. Dietary data was collected using a validated semi-quantitative, 147-item FFQ. Fruit and vegetables that contributed to the recommended five portions a day included all fresh, frozen and canned fruit and vegetables, pure fruit drinks, dried fruit, vegetable soups, tomato-based pasta sauces, baked beans and other pulses. Potatoes and nuts were excluded. In order to estimate the number of servings of fruit and vegetables consumed on a daily basis, frequency of consumption was converted to a single daily serving. The number of servings of fruit and vegetables was then calculated by adding the daily value for each relevant fruit/vegetable item. Statistical analysis was conducted using PASW (version 18.0). Overall, fruit and vegetable intake was below the recommended 5+ servings (see Table). The most commonly consumed vegetables were carrots, parsnips/turnips and cabbage, while the most commonly consumed fruit items were pure fruit drinks, bananas and apples. A large proportion of subjects (71.7%) did not meet recommendations to consume 5 + servings of fruit and vegetables daily. Almost half (46.5%) of these subjects consumed less than three servings a day. Percentage compliance with recommendations for other food groups was also poor. Over all, one-fifth (21.2%) of subjects consumed dietary supplements (including vitamin and mineral supplements) on a daily basis that may contribute to vitamin and mineral intakes.