Gloth F M, Gundberg C M, Hollis B W, Haddad J G, Tobin J D
Department of Medicine, Union Memorial Hospital, Baltimore, MD 21218, USA.
JAMA. 1995 Dec 6;274(21):1683-6. doi: 10.1001/jama.1995.03530210037027.
To assess the vitamin D status in homebound, community-dwelling elderly persons; sunlight-deprived elderly nursing home residents; and healthy, ambulatory elderly persons.
A cohort analytic study.
Of 244 subjects at least 65 years old, 116 subjects (85 women and 31 men) had been confined indoors for at least 6 months, either in private dwellings in the community (the Hopkins Elder Housecall Program) or in a teaching nursing home (The Johns Hopkins Geriatrics Center). The 128 control subjects, a healthy ambulatory group, came from the Baltimore Longitudinal Study on Aging. All subjects were free of diseases or medications that might interfere with their vitamin D status.
Serum levels of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-[OH]2D) were measured in all subjects. In a subgroup of 80 subjects, serum levels of intact parathyroid hormone (PTH), ionized calcium, and osteocalcin and intake of vitamin D (through 3-day food records) were assessed. A randomly selected cohort of sunlight-deprived subjects also had serum levels of vitamin D binding protein measured.
In sunlight-deprived subjects overall, the mean 25-OHD level was 30 nmol/L (12 ng/mL) (range, < 10 to 77 nmol/L [< 4 to 31 ng/mL]) and the mean 1,25-(OH)2D level was 52 pmol/L (20 pg/mL) (range, 18 to 122 pmol/L [7 to 47 pg/mL]). In the sunlight-deprived subjects, 54% of community dwellers and 38% of nursing home residents had serum levels of 25-OHD below 25 nmol/L (10 ng/mL) (normal range, 25 to 137 nmol/L [10 to 55 ng/mL]). A significant inverse relationship existed between 25-OHD (ie, Log [25-OHD]) and PTH when they were analyzed together (r = -0.42; R2 = 0.18; P < .001) and for each cohort separately. All other parameters measured, except ionized calcium, differed significantly from the Baltimore Longitudinal Study Group means. The mean (SD) daily intakes of vitamin D (121 [132] IU) and calcium (583 [322] mg) were below the recommended dietary allowance only in the community-dwelling homebound population. The mean vitamin D binding protein level in the sunlight-deprived subgroup was in the normal range.
Despite a relatively high degree of vitamin supplementation in the United States, homebound elderly persons are likely to suffer from vitamin D deficiency.
评估居家、居住在社区的老年人；缺乏阳光照射的老年疗养院居民；以及健康、能自主活动的老年人的维生素D状况。
一项队列分析研究。
在244名至少65岁的受试者中，116名受试者（85名女性和31名男性）被限制在室内至少6个月，他们要么居住在社区的私人住宅中（霍普金斯老年家访项目），要么住在一家教学疗养院（约翰霍普金斯老年医学中心）。128名对照受试者，即一个健康的能自主活动的群体，来自巴尔的摩纵向衰老研究。所有受试者均无可能干扰其维生素D状况的疾病或药物。
测量所有受试者血清25-羟维生素D（25-OHD）和1,25-二羟维生素D（1,25-[OH]2D）水平。在80名受试者的亚组中，评估血清完整甲状旁腺激素（PTH）、离子钙和骨钙素水平以及维生素D摄入量（通过3天的饮食记录）。一组随机选择的缺乏阳光照射的受试者还检测了维生素D结合蛋白血清水平。
总体而言，在缺乏阳光照射的受试者中，25-OHD平均水平为30 nmol/L（12 ng/mL）（范围，<10至77 nmol/L [<4至31 ng/mL]），1,25-(OH)2D平均水平为52 pmol/L（20 pg/mL）（范围，18至122 pmol/L [7至47 pg/mL]）。在缺乏阳光照射的受试者中，54%的社区居民和38%的疗养院居民血清25-OHD水平低于25 nmol/L（10 ng/mL）（正常范围，25至137 nmol/L [10至55 ng/mL]）。当一起分析时，25-OHD（即Log [25-OHD]）与PTH之间存在显著的负相关关系（r = -0.42；R2 = 0.18；P <.001），且在每个队列中分别分析时也是如此。除离子钙外，所有其他测量参数与巴尔的摩纵向研究组的均值有显著差异。仅在居家的社区居民中，维生素D（121 [132] IU）和钙（583 [322] mg）的平均（标准差）每日摄入量低于推荐膳食摄入量。缺乏阳光照射亚组中的维生素D结合蛋白平均水平在正常范围内。
尽管美国的维生素补充程度相对较高，但居家老年人仍可能存在维生素D缺乏。
