Vitamin D deficiency and its associated factors among older adults in Alborz province, Iran

Maryam Zarei PhD in Community Nutrition

Department of Nutrition and dietetics Faculty of Medicine and Health Sciences

University Putra Malaysia

Acknowledgements

• Participants

• Ministry of Health, Iran

• Alborz Medical University

• Dr Geeta Appannah

• Co-supervisors – AP Dr Norhasmah Sulaiman, AP Dr Subashini Thambiah, Dr Mostafa Qorbani

OUTLINE OF THE PRESENTATION

CONCLUSION

RESULTS

METHODOLOGY

INTRODUCTION

• Vitamin D is fat soluble seco-sterols.

• It has 2 forms; vitamin D2 (or ergocalciferol) and vitamin D3 (or

cholecalciferol).

• Vitamin D can be obtained from sunlight exposure, food, and

supplements.

Introduction

World prevalence of vitamin D deficiency among adults

Country References Percentage

Europe countries Cashman et al. 2016 40%

Iran Kelishadi et al., 2015 60%

Canada Riverin et al., 2014 40%

Australia Tiffany et al., 2014 23%

Malaysia Chin et al., 2014 % 5 Deficiency 22.7% insufficiency

USA Forrest et al., 2011 33%

Risk factors for vitamin D deficiency

• Female

• Age > 50

• Minimal sun exposure

• Dark skin

• Obesity

Holick et al., 2010, Suryanarayana et al., 2018

Problem statement • Vitamin D deficiency has been associated with various health

conditions-osteoporosis, heart disease and dementia

• In almost every country, aging is growing faster (WHO, 2015).

• The growth in population of the elderly came with particular

challenges-chronic diseases and physical disabilities

• The 2nd National Integrated Micronutrient Survey showed 80% of

Iranians were vitamin D deficient (UNICEF, 2014).

• However, there is a paucity of studies assessing vitamin D deficiency

and its associated factors among older adults in Iran.

Objectives

To assess the prevalence of vitamin D deficiency and its

associated factors including socio demographic, nutritional status,

dietary intake, sunlight exposure, health status and food security

status among older adults in Karaj city, Alborz province in Iran.

Methods

Methods

Study design: Cross sectional

• Study subjects : A total of 422 subjects aged 60-80 years were

recruited health centres in Karaj city in Alborz province,

Inclusion criteria Exclusion criteria

Iranian citizen Older adults who were diagnosed with Dementia, Alzheimer, Parkinson

Men and women age range over 60 to 80

Institutionalized; Disable older adults

Research questionnaire Research instrument

Sociodemographic information- age, gender, marital status, educational level, occupational status, the number of family members, household income, estimation of household expenses per month; financial and food aid from government, ownership Health status - any risk metabolic or diseases problem, use of medicine and use of vitamin D supplementation

Anthropometry measurement:- height, weight, BMI , waist circumference

Blood pressure measurement

Food insecurity: adapted Household Food Insecurity Access Scale (HFIAS) developed by USDA

Blood sample collection – A 3-mL blood sample was drawn by a qualified nurse.

Sun exposure- amount of time people spend in the sun during pass 3 months before recruitment (Score high and low)

Food frequency questionnaire- 117 food items

• Multiple logistic regression the relationship between socio-demographic status, socio-economic, anthropometric, sun light exposure, food insecurity, dietary intake and vitamin D level

• All statistical analyses SPSS (Version 22.0; SPSS Inc, Chicago, IL), was considered significant P <0.05 .

8/22/2018 12

Statistical Analysis

Results

Prevalence of vitamin D

Adjusted associates (odds ratio) of serum 25-hydroxyvitamin D deficiency

Variables Adjusted OR (95% CI) p-value

Occupations

Others

Housewife

1a

1.914

1.211 – 2.240

0.003*

Abdominal obesity

WC < 90 cm

WC ≥ 90 cm

1a

0.611

0.011 - 0.401

0.108

Hypertension

Normal < 130/ 85 mmHg

High ≥ 130/85 mmHg

1a

1.596

1.316 - 1.987

0.011*

Sun exposure score

High

Low

1a

1.350

1.202-1.557

0.001*

BMI Normal BMI < 30 kg/m2 Obese BMI ≥ 30 kg/m2

1a

1.895

1.629 - 2.331

0.001*

Most influencing associates of serum 25-Hydroxyvitamin D deficiency

Variables B Standard Error 95% CI p-value

BMI Normal BMI < 30 kg/m2 Obese BMI ≥ 30 kg/m2

1.603

0.103

1.109 - 1.915

0.011*

Hypertension

Normal < 130/ 85 mmHg

High ≥ 130/85 mmHg 1.456 0.126 1.103 - 1.609 0.001*

Sun exposure score

High

Low 1.116 0.0551 1.023 - 2.187 0.001*

Occupation level

Others

Housewife 1.054 0.0342 1.012-1.897 0.031*

• The prevalence of vitamin D deficiency is high among older adults in Alborz province, Iran.

• Older adults who were

• housewives,

• hypertensive,

• obese and

• had low sun exposure

• were more likely to be vitamin D deficient.

• Further studies are needed to substantiate these findings and for the development of appropriate

interventions to improve serum 25(OH)D levels in older adults

Discussion and conclusion