Journal List > J Nutr Health > v.49(6) > 1081469

J Nutr Health. 2016 Dec;49(6):437-446. Korean.
Published online December 31, 2016.  https://doi.org/10.4163/jnh.2016.49.6.437
© 2016 The Korean Nutrition Society
Vitamin D intake, serum 25OHD, and bone mineral density of Korean adults: Based on the Korea National Health and Nutrition Examination Survey (KNHANES, 2011)
Mi-Yeon Kim,1 Mi-Ja Kim,2 and Sun Yung Ly1
1Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea.
2Department of Food and Nutrition, Daejeon Institute of Science and Technology, Daejeon 35408, Korea.

To whom correspondence should be addressed. tel: +28-42-821-6838, Email: sunly@cnu.ac.kr
Received September 28, 2016; Revised November 09, 2016; Accepted November 15, 2016.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

The purpose of this study was to estimate dietary intake of vitamin D and the relationship between serum 25-hydroxyvitamin D (25OHD) concentration and bone mineral density (BMD) in Korean adults using the 2011 data from the Korea National Health and Nutrition Examination Survey.

Methods

Daily intake of vitamin D and ratio of subjects that consumed less vitamin D than adequate intake (AI) were estimated in 4,879 Korean adults. The relationship between daily intake of vitamin D and serum 25OHD and BMD were analyzed.

Results

Average daily intakes of vitamin D were 3.84 ± 0.23 µg/day for men and 2.22 ± 0.11 µg/day for women. Approximately 72~97% of men and 80~99% of women consumed less than the AI of vitamin D for Koreans. Serum 25OHD concentration increased with age, and the ratios of serum vitamin D deficiency (< 20 ng/mL) were 47.8~81.1% for men and 59.4~92.8% for women. Average intake of vitamin D was higher in subjects aged < 50 yr than in those ≥ 50 yr, but lower in serum 25OHD concentration. In subjects aged < 50 yr, serum 25OHD was higher in subjects that consumed 10 µg/day of vitamin D than in those that consumed less than 5 µg/day. In female subjects aged ≥ 50 yr, average intake of vitamin D was associated with higher bone mineral density.

Conclusion

It was found that dietary intake of vitamin D could increase serum 25OHD concentration in young adults and bone mineral density in old women. Therefore, nutrition policies for enriched foods with vitamin D and nutrition education to consume more vitamin D-rich foods are needed to ameliorate vitamin D status of the Korean population. Adequate intake for Korean population aged < 50 yr might be adjusted upwardly up to 10 µg/day.

Keywords: dietary intake of vitamin D; serum 25-hydroxyvitamin D; bone mineral density; Korean adults

Figures


Fig. 1
Flowchart of subject inclusion and exclusion in the Korea National Health and Nutrition Examination Survey 2011
Click for larger image


Fig. 2
Sun exposure-adjusted serum 25OHD concentrations by vitamin D intake level. Serum 25OHD concentrations is expressed as mean ± SE. Results from the complex samples general linear model. *p < 0.05, **p < 0.01
Click for larger image


Fig. 3
Serum 25(OH)D concentration-adjusted bone mineral density by vitamin D intake level in women over 50 yr. Bone mineral density is expressed as mean ± SE. WTBMD: wholebody total bone mineral density, THBMD: total hip bone mineral density, FNBMD: femur neck bone mi neral density, LSBMD: lumbar spine bone mineral density. Results from the complex samples general linear model. *p < 0.05
Click for larger image

Tables


Table 1
Characteristics of participants
Click for larger image


Table 2
Mean energy and vitamin D intakes and mean serum 25OHD concentration of Koreans, in 2011, by age and gender
Click for larger image


Table 3
Regression coefficient (95% CI) for association between serum vitamin D concentration and variables according to the sex
Click for larger image


Table 4
Contribution of vitamin D-rich food groups towards the daily mean intake of vitamin D in Korean adults
Click for larger image


Table 5
Bone mineral density at the total hip, femur neck, lumbar spine and wholebody of subject
Click for larger image

References
1. Shin CS, Choi HJ, Kim MJ, Kim JT, Yu SH, Koo BK, Cho HY, Cho SW, Kim SW, Park YJ, Jang HC, Kim SY, Cho NH. Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density. Bone 2010;47(2):378–387.
2. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANES V-1). . Cheongwon: Korea Centers for Disease Control and Prevention; 2011.
3. Tucker KL, Chen H, Hannan MT, Cupples LA, Wilson PW, Felson D, Kiel DP. Bone mineral density and dietary patterns in older adults: the Framingham osteoporosis study. Am J Clin Nutr 2002;76(1):245–252.
4. Nieves JW. Osteoporosis: the role of micronutrients. Am J Clin Nutr 2005;81(5):1232S–1239S.
5. Sowers M. Epidemiology of calcium and vitamin D in bone loss. J Nutr 1993;123 2 Suppl:413–417.
6. Lips P. Vitamin D physiology. Prog Biophys Mol Biol 2006;92(1):4–8.
7. Davis CD. Vitamin D and cancer: current dilemmas and future research needs. Am J Clin Nutr 2008;88(2):565S–569S.
8. Brannon PM, Yetley EA, Bailey RL, Picciano MF. Vitamin D and health in the 21st century: an update. proceedings of a conference held September 2007 in Bethesda, Maryland, USA. Am J Clin Nutr 2008;88(2):483S–592S.
9. Kim S, Lim J, Kye S, Joung H. Association between vitamin D status and metabolic syndrome risk among Korean population: based on the Korean National Health and Nutrition Examination Survey IV-2, 2008. Diabetes Res Clin Pract 2012;96(2):230–236.
10. Hwang YC, Ahn HY, Jeong IK, Ahn KJ, Chung HY. Optimal serum concentration of 25-hydroxyvitamin D for bone health in older Korean adults. Calcif Tissue Int 2013;92(1):68–74.
11. Holick MF. McCollum Award Lecture, 1994: vitamin D--new horizons for the 21st century. Am J Clin Nutr 1994;60(4):619–630.
12. Thuesen B, Husemoen L, Fenger M, Jakobsen J, Schwarz P, Toft U, Ovesen L, Jørgensen T, Linneberg A. Determinants of vitamin D status in a general population of Danish adults. Bone 2012;50(3):605–610.
13. Cinar N, Harmanci A, Yildiz BO, Bayraktar M. Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara, Turkey. Eur J Intern Med 2014;25(2):197–201.
14. Darling AL, Hart KH, Gibbs MA, Gossiel F, Kantermann T, Horton K, Johnsen S, Berry JL, Skene DJ, Eastell R, Vieth R, Lanham-New SA. Greater seasonal cycling of 25-hydroxyvitamin D is associated with increased parathyroid hormone and bone resorption. Osteoporos Int 2014;25(3):933–941.
15. Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF. Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 1992;75(4):1099–1103.
16. Matsuoka LY, Wortsman J, Hollis BW. Use of topical sunscreen for the evaluation of regional synthesis of vitamin D3. J Am Acad Dermatol 1990;22(5 Pt 1):772–775.
17. Kreiter SR, Schwartz RP, Kirkman HN Jr, Charlton PA, Calikoglu AS, Davenport ML. Nutritional rickets in African American breast-fed infants. J Pediatr 2000;137(2):153–157.
18. Yu A, Kim J, Kwon O, Oh SY, Kim J, Yang YJ. Associations between serum 25-hydroxyvitamin D and consumption frequencies of vitamin D rich foods in Korean adults and older adults. Korean J Community Nutr 2014;19(2):122–132.
19. Delvin EE, Imbach A, Copti M. Vitamin D nutritional status and related biochemical indices in an autonomous elderly population. Am J Clin Nutr 1988;48(2):373–378.
20. Villareal DT, Civitelli R, Chines A, Avioli LV. Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. J Clin Endocrinol Metab 1991;72(3):628–634.
21. McKenna MJ, Freaney R, Meade A, Muldowney FP. Hypovitaminosis D and elevated serum alkaline phosphatase in elderly Irish people. Am J Clin Nutr 1985;41(1):101–109.
22. Spiro A, Buttriss JL. Vitamin D: an overview of vitamin D status and intake in Europe. Nutr Bull 2014;39(4):322–350.
23. The Korean Nutrition Society. Dietary reference intakes for Koreans. 1st revision. Seoul: The Korean Nutrition Society; 2010.
24. Choe JS, Paik HY. Seasonal variation of nutritional intake and quality in adults in longevity areas. J Korean Soc Food Sci Nutr 2004;33(4):668–678.
25. Heo J, Park Y, Park HM. Dietary intake of nutrients and food in postmenopausal Korean women. J Korean Soc Menopause 2011;17(1):12–20.
26. Yoo K, Cho J, Ly S. Vitamin D intake and serum 25-hydroxyvitamin D levels in Korean adults: analysis of the 2009 Korea National Health and Nutrition Examination Survey (KNHANES IV-3) using a newly established vitamin D database. Nutrients 2016;8(10):E610.
27. The Korean Nutrition Society. Food values 2009. . Seoul: The Korean Nutrion Society; 2009.
28. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int 2005;16(7):713–716.
29. Harnack LJ, Steffen L, Zhou X, Luepker RV. Trends in vitamin D intake from food sources among adults in the Minneapolis-St Paul, MN, metropolitan area, 1980-1982 through 2007-2009. J Am Diet Assoc 2011;111(9):1329–1334.
30. Tsuboyama-Kasaoka N, Takizawa A, Tsubota-Utsugi M, Nakade M, Imai E, Kondo A, Yoshida K, Okuda N, Nishi N, Takimoto H. Dietary intake of nutrients with adequate intake values in the dietary reference intakes for Japanese. J Nutr Sci Vitaminol (Tokyo) 2013;59(6):584–595.
31. Okubo H, Sasaki S, Murakami K, Yokoyama T, Hirota N, Notsu A, Fukui M, Date C. Designing optimal food intake patterns to achieve nutritional goals for Japanese adults through the use of linear programming optimization models. Nutr J 2015;14:57.
32. Jayaratne N, Hughes MC, Ibiebele TI, van den, van der. Vitamin D intake in Australian adults and the modeled effects of milk and breakfast cereal fortification. Nutrition 2013;29(7-8):1048–1053.
33. Moore CE, Radcliffe JD, Liu Y. Vitamin D intakes of adults differ by income, gender and race/ethnicity in the U.S.A., 2007 to 2010. Public Health Nutr 2014;17:756–763.
34. Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007;(158):1–235.
35. Koo JO, Lim HS, Jung YJ, Yoon JS, Lee YR, Lee JH. In: Understanding basic nutrition. Seoul: Powerbook; 2008.
36. Adams JS, Kantorovich V, Wu C, Javanbakht M, Hollis BW. Resolution of vitamin D insufficiency in osteopenic patients results in rapid recovery of bone mineral density. J Clin Endocrinol Metab 1999;84(8):2729–2730.
37. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337(10):670–676.
38. Nikooyeh B, Neyestani TR, Zahedirad M, Mohammadi M, Hosseini SH, Abdollahi Z, Salehi F, Mirzay Razaz J, Shariatzadeh N, Kalayi A, Lotfollahi N, Maleki MR. Vitamin D-fortified bread is as effective as supplement in improving vitamin D status: a randomized clinical trial. J Clin Endocrinol Metab 2016;101(6):2511–2519.
39. Allen RE, Dangour AD, Tedstone AE, Chalabi Z. Does fortification of staple foods improve vitamin D intakes and status of groups at risk of deficiency? A United Kingdom modeling study. Am J Clin Nutr 2015;102(2):338–344.