Food insecurity and vitamin D deficiency factors, and effects of vitamin D supplementation on metabolic syndrome among food insecure and vitamin D deficient Iranian elderly
In almost every country, elderly population is growing faster than any other age groups with its age-related lifestyle changes, physical disabilities potentially chronic disease ultimately forcing them to remain indoors. The above factors may directly affect their ability to have access to food a...
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| Format: | Thesis |
| Language: | English |
| Published: |
2019
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| Subjects: | |
| Online Access: | http://psasir.upm.edu.my/id/eprint/84293/1/FPSK%20%28p%29%202019%2027%20UPM%20ir.pdf |
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| Summary: | In almost every country, elderly population is growing faster than any other age groups
with its age-related lifestyle changes, physical disabilities potentially chronic disease
ultimately forcing them to remain indoors. The above factors may directly affect their
ability to have access to food as well as potentially being impacted by food insecurity.
Food insecurity can contribute to poor health and nutrition deficiency of which vitamin
D deficiency is the most common one seen in older adults. Although there are
numerous studies have been conducted on the effects of vitamin D supplementation in
adults, but little or no data has been reported on the effects of vitamin D
supplementation in older adults with vitamin D deficiency, especially amongst Iranian
older adults. This study comprised of two phases; the first phase was a cross-sectional,
conducted to determine the prevalence and factors associated with food insecurity and
vitamin D deficiency among older adults in Karaj city, Iran. Study subjects were
recruited based on a defined set of inclusion criteria via systematic random sampling.
An interviewer-administered questionnaire was used to capture information on
socioeconomic characteristics, medical history, and food security status, sun exposure
and food frequency questionnaire (FFQ). Anthropometric measurements including
weight, height and waist circumference as well as blood pressure were measured by
trained research staff directly after the interview. Fasting blood samples were collected
for quantifying serum 25-hydroxyvitamin D [25(OH) D] level. Adjusted logistic
regression was used to identify associations between food insecurity, vitamin D
deficiency and selected predictor variables. The second phase of this study was a
randomized control trial (RCT) to examine the effects of vitamin D supplementation
on metabolic syndrome parameters such as [body mass index (BMI), waist
circumference (WC), blood pressure (BP), total cholesterol (TC), triglyceride (TG),
low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), fasting blood
sugar (FBS)], and as well as 25(OH)D concentration among food insecure and vitamin D deficient older adults, before and after 2 months supplementation with vitamin D in
Karaj city, Iran. Out of 422 subjects from phase I, a total of 120 food insecure subjects
were enrolled into phase 2 of the study. Food insecure subjects were vitamin D
deficient (< 30 ng/ml), and with at least one metabolic syndrome parameters (from
self-reported medical history) were included to phase two via simple allocation
randomisation. The subjects (60 intervention and 60 placebo) were assigned to receive
either weekly vitamin D supplement (intervention group: 50,000 IU 25(OH) D3) or a
placebo capsule (placebo group) for two months. Fasting blood samples were collected
for quantifying serum 25(OH) D level, FBS and lipid profile at baseline and after
completing two months treatment. Anthropometric characteristics, blood pressure
(BP) and blood collection were monitored by using analysis of covariance at baseline
and after intervention. Result from phase one showed that 31.7% older adults were
food insecure while 60.4% were vitamin D deficient with a higher rate among the
females. Logistic regression analysis indicated that a minimum household income of
800,000 T (160 $USD), and having more than three metabolic syndrome parameters
significantly increased the odds of food insecurity by almost 16-fold (AOR = 16.27,
95% CI = 8.09 - 30.28) and 5-fold (AOR = 4.615, 95% CI = 2.654 - 8.877),
respectively. Obese respondents had significantly higher odds (AOR = 3.105, 95% CI
= 1.933 - 4.987) of food insecurity by almost three-fold. Food insecure older adults
were more likely to consume high energy (AOR = 1.477, 95% CI = 1.139 - 1.944),
and carbohydrate (AOR = 1.710, 95% CI = 1.112 - 2.631) intakes compared to food
secure older adults. Food insecure older adults were also more likely to be vitamin D
deficient (AOR = 1.472, 95% CI = 0.953 - 2.273). In addition, being a female
increased odds of vitamin D deficiency by two-fold (AOR = 1.810; 95% CI = 1.181-
2.772), whilst obesity increased odds of vitamin D deficiency by almost five-fold
(AOR = 4.703; 95% CI = 2.312 - 9.566). In phase two of the study, supplementation
of vitamin D3 for two months improved mean change of FBS, TG, TC, LDL-C and
systolic BP (p = 0.004, p = 0.001, p = 0.001, p = 0.003, p = 0.001, respectively), and
resulted in a significant improvement of mean serum 25(OH) D concentration in the
intervention group compared to the control group (p = 0.001). No significant
differences were observed when comparing body weight status, WC, diastolic BP and
HDL-C between intervention and control groups at baseline and after intervention. In
summary, this study indicated that a significant level of food insecurity is present in
older adults in Iran which was associated with socioeconomic factors, dwelling
arrangements. This in turn affected prevalence of chronic diseases such as vitamin D
deficiencies and decreased health-related quality of life in older adults. Vitamin D
deficiency had detrimental effects on health in older adults while vitamin D
supplementation improves vitamin D status and a number of risk factors for
cardiovascular disease. Therefore, replenishing vitamin D levels in older adults could
reduce premature morbidity and mortality in food insecure older adults. |
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