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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
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