taking care of the whole self: vitamin d and calcium’s
TRANSCRIPT
Taking Care of the Whole Self: Vitamin D and Calcium’s Role in Overall Health
Rhianna Cenci, Sodexo Dietetic Intern Susan Hurd, RD LDN Michael Kostalis, Chef Moravian College Dining Services Sodexo
Vitamin D
• Fat-‐soluble vitamin (A, D, E, K) • Must be activated in the body ▫ In the liver: converts vitamin D to 25-‐hydroxyvitaminD [25(OH)D] aka calcidiol
▫ In the kidney: forms active 1,25-‐dihydroxyvitaminD [1,25(OH)2D] aka calcitriol
Functions of Vitamin D in the Body
• Promotes calcium absorption in the gut • Maintains adequate serum calcium and phosphate concentrations
• Needed for bone growth and remodeling • Modulation of cell growth • Neuromuscular and immune function • Reduction of inSlammation
Recommended Dietary Allowances (RDAs) for Vitamin D Age Male Female Pregnancy Lactation 0-‐12 months* 400 IU
(10 mcg) 400 IU (10 mcg)
1-‐13 years 600 IU (15 mcg)
600 IU (15 mcg)
14-‐18 years 600 IU (15 mcg)
600 IU (15 mcg)
600 IU (15 mcg)
600 IU (15 mcg)
19-‐50 years 600 IU (15 mcg)
600 IU (15 mcg)
600 IU (15 mcg)
600 IU (15 mcg)
51-‐70 years 600 IU (15 mcg)
600 IU (15 mcg)
>70 years 800 IU (20 mcg)
800 IU (20 mcg)
*Adequate Intake (AI) Institute Of Medicine, 2010
Where is Vitamin D?
Food Source Serving Amount
Cod liver oil 1 tbsp 1360 IUs SwordSish, cooked 3 oz 566 IUs Salmon (sockeye), cooked 3 oz 447 IUs Tuna Sish, canned in water, drained
3 oz 154 IUs
Orange juice (fortiSied with vitamin D)
1 cup 137 IUs
Milk, vitamin D-‐fortiSied 1 cup 115-‐124 IUs Yogurt (fortiSied with 20% DV) 6 oz 80 IUs
Where is Vitamin D?
Food Source Serving Amount
Margarine, fortiSied 1 tbsp 60 IUs Sardines, canned in oil, drained 2 sardines 46 IUs Liver, beef, cooked 3 oz 42 IUs Egg 1 large 41 IUs Ready-‐to-‐eat cereal, fortiSied with 10% DV for vitamin D
¾-‐1 cup 40 IUs
Cheese, Swiss 1 oz 6 IUs
Sources of Vitamin D
• Infant formulas fortiSied with vitamin D: 40-‐100 IU
• Sun exposure ▫ UV rays trigger vitamin D synthesis ▫ SPF 8+ appears to block rays ▫ 5-‐30 minutes of sunlight between 10am-‐3pm twice per week should maintain vitamin D levels ▫ Skin cancer risks
Vitamin D Supplements
• Ergocalciferol (D2) • Cholecalciferol (D3)
• Both forms will raise vitamin D levels • Metabolized the same way • At high doses, D2 is less potent
• Breastfed infants: 400 IU/day
Vitamin D Status in the Body
• Serum concentration of 25(OH)D is best indicator • Half-‐life of 15 days
• 1,25(OH)2D (active form) is not good indicator • Half-‐life of 15 hours • Levels regulated by the body • Do not typically decrease until deSiciency is severe
Serum 25-Hydroxyvitamin D Concentrations and Health Status nmol/L* ng/mL* Health Status
<30 <12 Associated with vitamin D deSiciency, leading to rickets in infants and children and osteomalacia in adults
30-‐50 12-‐20 Generally considered inadequate for bone and overall health in healthy individuals
≥50 ≥20 Generally considered adequate for bone and overall health in healthy individuals
>125 >50 Emerging evidence links potential adverse effects to such high levels, particularly >150 nmol/L (>60 ng/mL)
* 1 nmol/L = 0.4 ng/mL * nanomoles per liter (nmol/L) and nanograms per milliliter (ng/mL)
Vitamin D Deficiency At risk: • Breastfed infants • Older adults • People with limited sun exposure • People with dark skin • People with fat malabsorption • Obese individuals • Gastric bypass surgery
Vitamin D Deficiency
• Brittle, thin, misshapen bones
• Rickets in children
• Osteomalacia in adults
• Osteoporosis in older adults
Bones
• Peak bone formation ages 9-‐14
• Peak bone mass at age 30
Calcium
• Most abundant mineral in the body
• <1% used for critical functions in body
• 99% of stores supplied in bones and teeth
Functions of Calcium
• Vascular constriction and vasodilation • Muscle function • Nerve transmission • Intracellular signaling • Hormonal secretion • Supports bone and teeth structure and function
Recommended Dietary Allowances (RDAs) for Calcium Age Male Female Pregnant Lactation
0-‐6 months* 200 mg 200 mg 7-‐12 months* 260 mg 260 mg 1-‐3 years 700 mg 700 mg 4-‐8 years 1000 mg 1000 mg 9-‐13 years 1300 mg 1300 mg 14-‐18 years 1300 mg 1300 mg 1300 mg 1300 mg 19-‐50 years 1000 mg 1000 mg 1000 mg 1000 mg 51-‐70 years 1000mg 1200 mg >70 years 1200 mg 1200 mg
*Adequate Intake (AI); Institute Of Medicine, 2010
Where is Calcium? Food Source Serving Amount
Yogurt, plain, low fat 8 oz 415 mg Mozzarella, part-‐skim 1.5 oz 333 mg Sardines, canned in oil, with bones 3 oz 325 mg Yogurt, fruit, low fat 8 oz 313-‐384 mg Cheddar cheese 1.5 oz 307 mg Milk, nonfat 8 oz 299 mg Soymilk, calcium-‐fortiSied 8 oz 299 mg Milk, reduced fat (2%) 8 oz 293 mg Milk, whole (3.25%) 8 oz 276 mg Orange juice, calcium-‐fortiSied 6 oz 261 mg Tofu, Sirm, made with calcium sulfate ½ cup 253 mg Tofu, soft, made with calcium sulfate ½ cup 138 mg
Food Source Serving Amount
Salmon, pink, canned, solids with bone 3 oz 181 mg Cottage cheese, 1% milk fat 1 cup 138 mg Ready-‐to-‐eat cereal, calcium-‐fortiSied 1 cup 100-‐1000mg Frozen yogurt, vanilla, soft serve ½ cup 103 mg Turnip greens, fresh, boiled ½ cup 99 mg Kale, raw, chopped 1 cup 100 mg Kale, fresh, cooked 1 cup 94 mg Ice cream, vanilla ½ cup 84 mg Chinese cabbage, bok choi, raw 1 cup 74 mg Bread, white 1 slice 73 mg Pudding, chocolate, ready-‐to-‐eat 4 oz 55 mg Tortilla, Slour or corn 1 6” round 32-‐46 mg Bread, whole wheat 1 slice 30 mg Broccoli, raw ½ cup 21 mg
Calcium Supplements
• Calcium carbonate ▫ More available, inexpensive, convenient ▫ More GI side effects ▫ In some medicines
• Calcium citrate
• Many have added vitamin D
Calcium Absorption
• Only absorb 30% of the calcium you eat
• The body absorbs more when needed (up to 60%) ▫ Pregnancy, periods of growth
• Vitamin D helps calcium absorption
Calcium Deficiency
At risk:
• Postmenopausal women • Amenorrheic women & female athlete triad • Lactose intolerance & cow’s milk allergy • Vegetarians & vegans
Calcium Deficiency
• Not enough calcium from the diet, then calcium pulls from the bones to keep level in blood steady
• Rickets in kids (with vitamin D deSiciency)
• Osteopenia Osteoporosis
• Hypocalcemia is rare
1-Day Menu Example
Breakfast: 3 scrambled eggs (2 whole, 1 egg white) with tomatoes, broccoli, and cheese, and 1 cup skim milk
Lunch: Sandwich with 2 slices whole wheat bread, turkey, lettuce, honey mustard, and sweet potato chips Dinner: Baked chicken breast with quinoa and carrots
Snack: 1 banana, 1 ounce almonds (handful)
55 yr old female Recommendations: 1200 mg calcium 600 IU vitamin D
Dessert: Vanilla ice cream
1-Day Menu Example Food Source Calcium Vitamin D
2 egg yolks -‐-‐ 82 IU Broccoli, ½ cup 21 mg -‐-‐ Cheddar cheese, 1-‐2 slices 307 mg 6 IU Skim milk, 1 cup 299 mg 115 IU Almonds, 1 oz 80 mg -‐-‐ Whole wheat bread, 2 slices 60 mg -‐-‐ Quinoa, ½ cup cooked 15 mg -‐-‐ Carrots, 1 cup cooked 40 mg -‐-‐ Vanilla ice cream, 1 cup 168 mg -‐-‐ TOTAL: 990 mg 203 IU
Recommendations: 1200 mg 600 IU
None from: Breakfast: Tomatoes
Snack: Banana
Lunch: Turkey, lettuce, honey mustard, sweet potato chips
Dinner: Chicken
Osteoporosis
• Loss of bone density with porous/fragile bones • 10+ million U.S. adults ▫ 80% women
• Hormone-‐related • Too little exercise and too little calcium increases risks for fractures ▫ 1.5 million fractures per year in U.S. ▫ Hip, vertebrae, wrist, pelvis, ribs
Normal bone vs. Osteoporosis
Long-Term Supplementation of Calcium and Vitamin D Study
• 36,000+ postmenopausal women aged 50-‐79 yrs • 1000mg calcium carbonate + vitamin D3 400 IU daily, or placebo, for ~7 years
• Follow-‐up 5 years later: ▫ 29% reduction in risk for hip fracture
▫ SigniSicant 13% reduction in vertebral fracture ▫ SigniSicant improvement in bone density of hip
Long-Term Supplementation of Calcium and Vitamin D Study
• Longer-‐term follow-‐up: ▫ SigniSicant 13% reduction in in situ breast cancer ▫ With low baseline intake of vitamin D, signiSicant 9% reduction in total cancer
▫ SigniSicant 9% reduction in all-‐cause mortality
• Other studies?
Resources
National Institutes of Health Institute of Medicine Journal of Women’s Health Medscape United States Dept. of Agriculture (USDA)
Thank you! Questions? Comments?