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Osteoporosis International

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Open Access 01-02-2012 | Original Article

A study of relationships between bone-related vitamins and minerals, related risk markers, and subsequent mortality in older British people: the National Diet and Nutrition Survey of People Aged 65 Years and Over

Authors: C. J. Bates, M. Hamer, G. D. Mishra

Published in: Osteoporosis International | Issue 2/2012

Abstract

Summary

Follow-up of a British national survey of older people found that in men, all-cause mortality was predicted by baseline plasma concentrations of phosphorus, albumin, creatinine and α1-antichymotrypsin, and food energy intake and in women by plasma alkaline phosphatase, creatinine, α1-antichymotrypsin, 25-hydroxy-vitamin D (marginally), and phosphorus intake.

Introduction

Predictive power, for all-cause mortality, of bone-related vitamin and mineral indices and intakes, measured at baseline (primary objective), was studied in the British National Diet and Nutrition Survey (community-living subset) of People Aged 65 Years and Over. A secondary objective was to identify cross-sectional relationships between indices at baseline to help explain mortality predictions.

Methods

Mortality status was recorded for 1,054 (mean age 76.6 ± 7.4 years, 49.0% female) participants from baseline survey in 1994/1995 until September 2008. Seventy-four per cent of male and 62% of female participants died. Cox proportional hazards models were used to relate baseline nutrient and risk marker estimates to subsequent survival. Results below 1.0 signified lower risk at greater nutrient (status or intake) values and vice versa.

Results

In both sexes, all-cause mortality was significantly predicted by body weight and mid-upper arm circumference. In men, it was predicted by baseline plasma concentrations (per SD) of: phosphorus (hazard ratio 1.18, 95% confidence interval (CI) = 1.06–1.30), albumin (hazard ratio 0.84, 95% CI = 0.74–0.94), creatinine (hazard ratio 1.20, 95% CI = 1.08–1.33) and α₁-antichymotrypsin (hazard ratio 1.21, 95% CI = 1.11–1.33). In women, it was predicted by plasma albumin (hazard ratio 0.83, 95% CI = 0.72–0.96), alkaline phosphatase (hazard ratio 1.08, 95% CI = 1.01–1.16), creatinine (hazard ratio 1.37, 95% CI = 1.13–1.66), α₁-antichymotrypsin (hazard ratio 1.27, 95% CI = 1.11–1.45) and marginally by 25-hydroxy-vitamin D (hazard ratio 0.87, 95% CI = 0.75–1.00). In men, it was predicted by dietary intake (per SD) of food energy; in women, by intake of phosphorus. Adjustment for plasma α₁-antichymotrypsin or plasma creatinine reduced the significance of plasma phosphorus in men.

Conclusion

Mortality prediction by higher plasma phosphorus in older British men may imply impaired renal function and/or acute phase status. Further studies are needed on which associations are causal and modifiable.

Bates CJ, Hamer M, Mishra GD (2011) Redox-modulatory vitamins and minerals that prospectively predict mortality in older British people: the National Diet and Nutrition Survey of people aged 65 years and over. Br J Nutr 105:123–132

Bates CJ, Mansoor MA, Pentieva KD, Hamer M, Mishra GD (2010) Biochemical risk indices, including plasma homocysteine, that prospectively predict mortality in older British people: the National Diet and Nutrition Survey of People Aged 65 Years and Over. Br J Nutr 104:893–899PubMedCrossRef

Hamer M, Bates CJ, Mishra GD (2011) Depression, physical function, and risk of mortality: National Diet and Nutrition Survey in older adults 65+ yrs. Am J Geriatr Psychiatr 19:72–78CrossRef

Hamer M, McNaughton SA, Bates CJ, Mishra GD (2010) Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom. Eur J Clin Nutr 64:853–861PubMedCrossRef

Finch S, Doyle W, Lowe C, Bates CJ, Prentice A, Smithers G, Clarke PC (1998) National Diet and Nutrition Survey: People Aged 65 Years or Over, vol 1. Report of the Diet and Nutrition Survey. London, The Stationery Office. http://www.data-archive.ac.uk/doc/4036%5Cmrdoc%5Cpdf%5Ca4036ueb.pdf

Kistorp C, Raymond I, Pedersen F, Gustaffsson F, Faber J, Hildebrandt P (2005) N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 293:1609–1616PubMedCrossRef

Dhingra R, Sullivan LM, Fox CS, Wang TJ, D’Agostino RB, Gaziano JM (2007) Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 167:879–885PubMedCrossRef

Tonelli M, Curhan G, Pfeffer M, Sacks F, Thadhani R, Melamed ML, Wiebe N, Muntner P (2009) Relation between alkaline phosphatase, serum phosphate, and all-cause or cardiovascular mortality. Circulation 120:1784–1792PubMedCrossRef

Larsson TE, Olauson H, Hagstrom E, Ingelsson E, Arnlov J, Lind L, Sundstrom J (2010) Conjoint effects of serum calcium and phosphate on risk of total, cardiovascular, and noncardiovascular mortality in the community. Arterioscler Thromb Vasc Biol 30:333–339CrossRef

10.

Hollis BW, Kamerud JQ, Selvaag SR, Lorenz JD, Napoli JL (1993) Determination of vitamin D status by radioimmunoassay with an ¹²⁵I-labelled tracer. Clin Chem 39:529–533PubMed

11.

Bates CJ, Carter GD, Mishra GD, O’Shea D, Jones J, Prentice A (2003) In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? A study of people aged 65 years and over from the British National Diet and Nutrition Survey. Osteoporos Int 14:152–159PubMed

12.

Barth J, Fiddy J, Payne R (1996) Adjustment of serum total calcium for albumin concentration: effects of non-linearity and of regression differences between laboratories. Ann Clin Biochem 33:55–58PubMed

13.

Kannel WB (2002) Coronary heart disease risk factors in the elderly. Am J Geriatr Cardiol 11:101–107PubMedCrossRef

14.

de Ruijter W, Westendorp RGJ, Assendelft WJJ, den Elzen WPJ, de Craen AJM, le Cessie S, Gussekloo J (2009) Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ 338:a3083PubMedCrossRef

15.

Sambrook PN, Chen JS, March LM, Cameron ID, Cumming RG, Lord SR, Schwarz J, Seibel MJ (2004) Serum parathyroid hormone is associated with increased mortality independent of 25-hydroxy vitamin D status, bone mass, and renal function in the frail and very old: a cohort study. J Clin Endocrinol Metab 89:5477–5481PubMedCrossRef

16.

Jia X, Aucott LS, McNeill G (2007) Nutritional status and subsequent all-cause mortality in men and women aged 75 years or over living in the community. Br J Nutr 98:593–599PubMedCrossRef

17.

Autier P, Gandini S (2007) Vitamin D supplementation and total mortality. A meta-analysis of randomized controlled trials. Arch Intern Med 167:1730–1737PubMedCrossRef

18.

Melamed ML, Michos ED, Post W, Astor B (2008) 25-Hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRef

19.

Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeidei J, Boehm BO, Weihrauch G, Maerz W (2008) Independent association of low serum 25-hydroxyvitamin and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 168:1340–1349CrossRef

20.

Pilz S, Dobnig H, Nijpels G, Heine RJ, Stehouwer CD, Snijder MB, van Dam RM, Dekker JM (2009) Vitamin D and mortality in older men and women. Clin Endocrinol 71:666–672CrossRef

21.

Semba RD, Houston DK, Ferrucci L, Cappola AR, Sun K, Gurainik JM, Fried LP (2009) Low serum 25-hydroxyvitamin D concentrations are associated with greater all-cause mortality in older community-dwelling women. Nutr Res 29:525–530PubMedCrossRef

22.

Kilkkinen A, Knekt P, Aro A, Rissanen H, Marniemi J, Heliovaara M, Impivaara O, Reunanen A (2009) Vitamin D status and the risk of cardiovascular death. Am J Epidemiol 170:1032–1039PubMedCrossRef

23.

Zitterman A, Gummert JF, Borgermann J (2009) Vitamin D deficiency and mortality. Curr Opin Clin Nutr Metab Care 12:634–639CrossRef

24.

Ginde AA, Scragg R, Schwartz RS, Camargo CA (2009) Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc 57:1595–1603PubMedCrossRef

25.

Fiscella K, Franks P (2010) Vitamin D, race, and cardiovascular mortality: findings from a national US sample. Ann Fam Med 8:11–18PubMedCrossRef

26.

Chen JS, Sambrook PN, March L, Cameron ID, Cumming RG, Simpson JM, Seibel MJ (2008) Hypovitaminosis D and parathyroid hormone response in the elderly: effects on bone turonover. Clin Endocrinol 68:290–298

27.

Bjorkman MP, Sorva AJ, Tilvis RS (2008) Elevated serum parathyroid hormone predicts impaired survival prognosis in a general aged population. Eur J Endocrinol 158:749–753PubMedCrossRef

28.

Hagstrom E, Hellman P, Larsson TE, Ingelsson E, Berglund L, Sundstrom J, Melhus H, Held C, Lind L, Michaelsson K, Arnlov J (2009) Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 119:2765–2771PubMedCrossRef

29.

Steele JG, Sheiham A, Marcenes W, Walls AWG (1998) National Diet and Nutrition Survey: People Aged 65 Years and Over, vol 2. Report of the Oral Health Survey. The Stationery Office, London

30.

Cooper R, Kuh D, Hardy R, Mortality Review Group, FALCon and HALCyon Study Teams (2010) Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 341:c4467PubMedCrossRef

31.

Cawthon PM, Marshall LM, Michael Y, Dam TT, Ensrud KE, Barrett-Connor E et al (2007) Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc 55:1216–1223PubMedCrossRef

32.

Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL et al (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 168:382–389PubMedCrossRef

33.

Department of Health (1991) Dietary reference values for food energy and nutrients for the United Kingdom. Report on Health and Social Subjects, no. 41, HMSO, London

34.

Department of Health (1998) Nutrition and bone health, with particular reference to calcium and vitamin D, no. 49. The Stationery Office, London

35.

Scientific Advisory Committee on Nutrition (2007) Update on vitamin D. The Stationery Office, London

36.

Standing Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board, Institute of Medicine (1997) Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. National Academy Press, Washington DC

37.

Institute of Medicine (2010) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington DC

Title: A study of relationships between bone-related vitamins and minerals, related risk markers, and subsequent mortality in older British people: the National Diet and Nutrition Survey of People Aged 65 Years and Over
Authors: C. J. Bates
M. Hamer
G. D. Mishra
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 2/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-011-1543-z

Keynote webinar | Spotlight on medication adherence

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A study of relationships between bone-related vitamins and minerals, related risk markers, and subsequent mortality in older British people: the National Diet and Nutrition Survey of People Aged 65 Years and Over

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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