Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D<sub>3</sub> (25OHD) concentration and parathyroid hormone (PTH) concentration

Patel, Prerna; Mughal, M Zulf; Patel, Peysh A; Yagnik, Bhrugu; Kajale, Neha; Mandlik, Rubina; Khadilkar, Vaman; Chiplonkar, Shashi; Phanse, Supriya; Patwardhan, Vivek; Patel, Ashish; Khadilkar, Anuradha

doi:10.1136/archdischild-2015-308985

Cited by 28 publications

(27 citation statements)

References 14 publications

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“…The serum 25(OH)D concentration usually is very low (< 15–20 nmol/l), unless a very low dietary calcium intake is the cause of the complaints. Serum PTH is elevated, but less so with a higher dietary calcium intake, than with a lower intake ( Patel et al, 2016 ). For the diagnosis, other causes of increased alkaline phosphatase should be excluded, such as Paget's disease or bone metastasis.…”

Section: Laboratory Examinationmentioning

confidence: 99%

Vitamin D deficiency in immigrants

Lips

Jongh

2018

Bone Reports

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Vitamin D deficiency and rickets are more common in non-western immigrants and refugees than in the native population. Severe vitamin D deficiency (serum 25-hydroxyvitamin D <25 nmol/l) may occur in up to 50% of children and adults of non-western origin. They are not used to sunshine exposure due to the often excessive sunshine in the country of origin. They usually have a more pigmented skin. Non-western immigrants and refugees often wear skin-covering clothes due to religious or cultural tradition. The food contains little vitamin D with the exception of fatty fish. In addition, many immigrants have a low calcium intake. Complaints may include fatigue, pain in shoulders, ribs, lower back and thighs. Neonates and young children may have spasms and convulsions due to hypocalcemia. Older children and adolescents may have bone pain, muscle weakness and skeletal deformities. Widening of the wrist, chest deformities and bowing of the legs may occur, and longitudinal growth is delayed. In adults, muscle weakness and bone pain are predominant. Laboratory examination may show hypocalcemia and hypophosphatemia and elevated alkaline phosphatase. The serum 25(OH)D is below 25 nmol/l in case of severe vitamin D deficiency with symptoms. Impaired 25-hydroxylation or 1α-hydroxylation may occur in case of severe liver or renal disease or by genetic causes. Radiographs of wrists or knees may show widening of the growth plates and cupping of radius and ulna may confirm the diagnosis. In adolescents and adults, radiographs of painful bones may show pseudofractures or Looser zones. Rickets and osteomalacia are treated by vitamin D3 2000 IU/d in infants, 3000–6000 IU/d in older children in combination with calcium 500 mg /d. In osteomalacia, the adult vitamin D3 dose is 2000–3000 IU/d, combined with calcium 1000–2000 mg/d. Prevention of vitamin D deficiency can be done with vitamin D3 400–800 IU/d, depending on age. Nutritional measures include fortification of milk or other foods.

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Section: Laboratory Examinationmentioning

confidence: 99%

Vitamin D deficiency in immigrants

Lips

Jongh

2018

Bone Reports

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“…Attempts have been made to define vitamin D deficiency based on the 25(OH)D level at which PTH concentrations starts to rise. There are, however, several draw backs to this method: 1) the variation in the association between PTH and 25(OH)D is large thus making it difficult to detect an inflection point and 2) the relationship is influenced by dietary calcium intakes and requirements ( Djennane et al, 2014 ; Aloia et al, 2006 ; Patel et al, 2016 ). Many studies conducted in adults and adolescents have shown an inverse relationship between 25(OH)D concentrations and PTH, however the actual point of inflection at which PTH starts to rise is a point of considerable debate ( Aloia et al, 2006 ; Guillemant et al, 1999 ; Harkness and Cromer, 2005 ).…”

Section: Pathophysiology Of Nutritional Ricketsmentioning

confidence: 99%

“…Below these thresholds (in boys at 33–39 nmol/L and in girls at 20–37 nmol/L), 25(OH)D levels were positively associated with total BMD, and inversely associated with serum PTH and TRAP5b; whereas above these thresholds no relationships were found ( Wu et al, 2015 ). The influence of dietary calcium intake on the relationship between serum 25(OH)D concentrations and PTH levels was shown in healthy Indian adolescents, in whom those with higher than median dietary calcium intakes but with similar 25(OH)D concentrations to the control group had lower PTH concentrations while those with lower dietary calcium intake had higher PTH concentrations ( Patel et al, 2016 ). Similarly, Djennana et al emphasized the significant influence of a low calcium diet on the increase in PTH concentrations in children with 25(OH)D levels >50 nmol/L ( Djennane et al, 2014 ).…”

Section: Pathophysiology Of Nutritional Ricketsmentioning

confidence: 99%

The roles of vitamin D and dietary calcium in nutritional rickets

Thandrayen

Pettifor

2018

Bone Reports

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The etiology and pathogenesis of nutritional rickets are becoming progressively clearer. Vitamin D deficiency has generally been considered the major or only player in the pathogenesis of nutritional rickets. However, recent research into calcium deficiency has now provided clinicians with reasons to investigate and manage patients with nutritional rickets more appropriately.The important question when assessing cases of nutritional rickets is: “Is it calcium or vitamin D deficiency or both that play a major role in the pathogenesis of the disease?”The case presentation in this review highlights the risk factors, clinical presentation and pathophysiology of nutritional rickets in a young South African black child from a semi-urban area in Johannesburg, a city with abundant sunshine throughout the year.

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“…[1314] Thus, it is a critical phase, wherein increased exposure to high fluoride with low dietary calcium intake and decreased serum 25 hydroxyvitamin D 3 (25OHD) concentration may have an impact on the bone and teeth mineralization. Therefore, the aim of this study was to examine: (a) the prevalence and association of dental and skeletal fluorosis in adolescents from different socioeconomic strata (SES) in an area endemic for fluorosis and (b) the association of dental and skeletal fluorosis with dietary calcium intake and serum 25OHD concentrations.…”

Section: Introductionmentioning

confidence: 99%

Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis

Patel

Zulf

et al. 2017

Indian J Endocr Metab

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Context:Fluorosis is controlled by the duration of fluoride exposure and calcium and Vitamin D nutrition status.Aim:To examine (a) prevalence of dental and skeletal fluorosis in adolescents from upper, middle, and lower socioeconomic strata (SES) and (b) association of fluorosis with calcium intake and Vitamin D status.Settings and Design:A cross-sectional study conducted in 10–13.9 years apparently healthy adolescents (n = 90), from different SES of Patan (Gujarat, India).Materials and Methods:Dental fluorosis was graded as mild, moderate, and severe. Radiographs of the right hand and wrist were examined and graded. Serum 25 hydroxyvitamin D3 (25OHD) and parathyroid hormone concentrations were measured. Diet was recorded (24 h recall) and calcium intake was computed (C-diet V-2.1, 2013, Xenios Technologies Pvt. Ltd).Statistical Analysis:Generalized linear model was used to analyze relationships between fluorosis, SES, serum 25OHD concentration, and calcium intake.Results:Fluorosis was predominant in lower SES (17% had both dental and radiological features whereas 73% had dental fluorosis); no skeletal deformities were observed. Mean 25OHD concentrations and dietary calcium were 26.3 ± 4.9, 23.4 ± 4.7, and 18.6 ± 4 ng/ml and 441.2 ± 227.6, 484.3 ± 160.9, and 749.2 ± 245.4 mg/day, respectively, for lower, middle, and upper SES (P < 0.05). Fluorosis and SES showed a significant association (exponential β = 2.5, P = 0.01) as compared to upper SES, middle SES adolescents were at 1.3 times while lower SES adolescents were at 2.5 times higher risk. Serum 25OHD concentrations (P = 0.937) and dietary calcium intake (P = 0.825) did not show a significant association with fluorosis.Conclusion:Fluorosis was more common in lower SES adolescents, probably due to the lack of access to bottled water. Relatively adequate calcium intake and serum 25OHD concentrations may have increased the efficiency of dietary calcium absorption, thus preventing severe fluorosis.

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Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D₃ (25OHD) concentration and parathyroid hormone (PTH) concentration

Abstract: Dietary calcium intake modifies the relationship between serum 25OHD concentrations and intact serum PTH concentrations. Thus, dietary calcium intake should be taken into account when assessing an individual's vitamin D status.

Cited by 28 publications

References 14 publications

Vitamin D deficiency in immigrants

Vitamin D deficiency in immigrants

The roles of vitamin D and dietary calcium in nutritional rickets

Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis

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Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D3 (25OHD) concentration and parathyroid hormone (PTH) concentration

Abstract: Dietary calcium intake modifies the relationship between serum 25OHD concentrations and intact serum PTH concentrations. Thus, dietary calcium intake should be taken into account when assessing an individual's vitamin D status.

Cited by 28 publications

References 14 publications

Vitamin D deficiency in immigrants

Vitamin D deficiency in immigrants

The roles of vitamin D and dietary calcium in nutritional rickets

Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis

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Product

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Dietary calcium intake influences the relationship between serum 25-hydroxyvitamin D₃ (25OHD) concentration and parathyroid hormone (PTH) concentration