Ugotavljanje preskrbljenosti z vitaminom D pri perimenopavznih in pomenopavznih ženskah

Vičič, Vid (author), Kukec, Andreja (mentor), Geršak, Ksenija (comentor), Pandel Mikuš, Ruža (comentor)

Uvod: Na preskrbljenost z vitaminom D vplivajo vedenjski in prehranski dejavniki. Namen doktorske naloge je bil oceniti preskrbljenost z vitaminom D, razlike med slovenskimi premenopavznimi in pomenopavznimi ženskami, starimi med 44 in 65 let ter razviti model, ki bi omogočal napovedovanje preskrbljenosti z vitaminom D brez določanja serumskih vrednosti. Metode: V obdobju med 1. marcem in 31. majem 2021 smo izvedli presečno epidemiološko študijo, v katero je bilo vključenih 319 žensk, starih med 44 in 65 let. V končno analizo smo vključili 176 preiskovank. Preskrbljenost z vitaminom D smo določili z meritvijo koncentracije skupnega 25-(OH) vitamina D (25(OH)D), vitamin D vezavnega proteina (DBP), albumina ter z izračunom biorazpoložlivega in prostega 25(OH)D. Za izračun obogatitvenega modela smo vsebnost vitamina D v neobogatenem mleku (vključno z jogurtom) in jajcih nadomestili z vsebnostjo v (bio)obogatenih živilih. Po 20 mesecih je bil udeleženkam poslan spletni vprašalnik za nadaljnje spremljanje. 123 udeleženk je odgovorilo s popolnimi podatki. Rezultati in diskusija: Pomanjkanje vitamina D (skupni 25(OH)D <50 nmol/L) je bilo ugotovljeno pri 29,0 % premenopavznih in 24,4 % pomenopavznih žensk. Nezadostnost vitamina D (skupni 25(OH)D <75 nmol/L) je bila ugotovljena pri 76,8 % premenopavznih in 61,7 % pomenopavznih žensk. Premenopavzne ženske so imele 11,8 % nižji skupni 25(OH)D in 32,2 % nižji biorazpoložljivi 25(OH)D kot pomenopavzne ženske. Razmerje obetov (OR) za nezadostnost vitamina D (skupni 25(OH)D <75 nmol/L) med preiskovankami, ki ne dodajajo vitamina D, je bilo OR = 6,23; p<0,001. Dodajanje vitamina D se je v primerjavi z obdobjem pred pandemijo povečalo za 7-krat in je po 20 mesecih ostalo na visoki ravni. (Bio)obogatitev bi lahko stroškovno učinkovito povečala povprečni vnos vitamina D iz 2,2±1,3 µg/d (brez obogatitve) na 10,5±6,5 µg/d (bioobogatitev jajc, obogatitev mleka in jogurta). Zaključki: Presejalni vprašalnik ne bi bil dovolj zanesljiv pri napovedovanju nizkih serumskih vrednosti skupnega 25(OH)D. Dodajanje vitamina D z zdravili in s prehranskimi dopolnili je za razliko od obogatitve živil, učinkovito le na individualni ravni. Cilj obogatitve živil mora biti izkoreninjenje hudega pomanjkanja vitamina D(25(OH)D <30 nmol/L) in preprečevanje pomanjkanja vitamina D (25(OH)D <50 nmol/L) pri večini prebivalstva. Za doseganje optimalnih vrednosti (>75 nmol/L) pa bi bilo med mesecem oktobrom in aprilom še vedno potrebno dodajanje vitamina D preko zdravil ali prehranskih dopolnil. V času pandemije covida-19, se promocija dodajanja vitamina D v medijih izkazala kot zelo uspešna, zato bi bilo to smiselno sistematično in kontinuirano izvajati.

• Language: Slovenian
• Keywords: vitamin D, 25(OH)D, D3, pomenopavzne ženske, premenopavzne ženske, covid-19, dodajanje vitamina D, obogatitev živil
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2024
• PID: 20.500.12556/RUL-156130
• Publication date in RUL: 10.05.2024

Secondary language

• Language: English
• Title: Assessment of vitamin D status of perimenopausal and postmenopausal women

Abstract

Introduction: Vitamin D status is influenced by behavioural and dietary factors. The aim of this doctoral thesis was to determine vitamin D status and differences between premenopausal and postmenopausal Slovenian women aged 44 to 65 years and to develop a model for predicting vitamin D status without measuring serum levels. Methods: A cross-sectional epidemiological study was conducted between 1 March and 31 May 2021 (during Covid-19 lockdown), involving 319 women aged 44 to 65 years. 176 participants were included in the final analysis. Vitamin D status was determined by measuring the concentration of total 25-hydroxyvitamin D (total 25(OH)D), vitamin D-binding protein (DBP), albumin and by calculating bioavailable and free 25(OH)D. For the fortification model calculations, the vitamin D contents of unenriched milk (including yoghurt) and eggs were replaced by enriched foods containing vitamin D. After 20 months an online follow-up questionnaire was sent out, to which 123 participants responded with complete data. Results and discussion: Vitamin D deficiency (total 25(OH)D <50 nmol/L) was found in 29.0 % of premenopausal and 24.4 % of postmenopausal women. Vitamin D insufficiency (total 25(OH)D <75 nmol/L) was found in 76.8 % of premenopausal and 61.7 % of postmenopausal women. In premenopausal women, total 25(OH)D levels were 11.8 % lower and bioavailable 25(OH)D levels were 32.2 % lower than in postmenopausal women. The odds ratio (OR) for vitamin D insufficiency (total 25(OH)D <75 nmol/L) among vitamin D non-supplementers was OR = 6.23; p<0.001. Vitamin D supplementation increased 7-fold compared to pre-pandemic levels and remained at a high level after 20 months. With (bio)fortification it would be possible to cost-effectively increase the average intake of vitamin D from 2.2±1.3 µg/d (no fortification) to 10.5±6.5 µg/d (biofortification of eggs, fortification of milk yoghurt) Conclusions: A screening questionnaire would not be reliable enough to predict low serum levels of total 25(OH)D. Vitamin D supplementation with medications and supplements has been shown to be an effective, although unlike food fortification, it is only effective at the individual level. The goal of food fortification should be to eradicate severe vitamin D deficiency (25(OH)D <30 nmol/L) and prevent vitamin D deficiency (25(OH)D <50 nmol/L) in the majority of the population. To achieve optimal values (>75 nmol/L), the addition of vitamin D through medication or food supplements would still be necessary from October to April. During the Covid-19 pandemic, the promotion of vitamin D supplementation in the media proved to be very successful, so it would make sense to implement it systematically and continuously.

• Keywords: vitamin D, 25(OH)D, D3, postmenopausal women, postmenopausal women, Covid-19, vitamin D supplementation, food fortification