Avaliação dos níveis de 25-hidroxivitamina D e de parâmetros de adiposidade como determinantes da adequação de suplementação de colecalciferol para idosos institucionalizados
Nenhuma Miniatura disponível
Arquivos
Data
2004
Autores
Canto-Costa, Marcelo Henrique da Silva [UNIFESP]
Orientadores
Hauache, Omar Magid [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A carencia de vitamina D e responsavel por perda de massa ossea, com consequente aumento do risco de fratura. Grande prevalencia de insufiCiência da vitamina D tem sido observada principalmente em idosos o que tem estimulado a realizacao de varios estudos sobre suplementacao da vitamina nestes individuos. Atualmente doses fixas de reposicao sao preconizadas, porem poucas avaliacoes sobre os fatores que influenciam os niveis plasmaticos da 25(OH)D apos suplementacao foram realizadas, o que motivou a realizacao deste estudo. Para analisar a relacao entre a elevacao plasmatica da 25(OH)D apos suplementacao e adiposidade, estudamos um grupo de 42 idosos institucionalizados acima de 65 anos de idade, 31 mulheres (M) e 11 homens (H) com indice de massa corporea variando de 15,62 a 36,68 Kg/m2. Objetivamos, assim, avaliar se ha necessidade de adequacao de dose de colecalciferol para idosos de acordo com sua massa adiposa. Dosagens basais de 25(OH)D, paratormonio (PTH), leptina, marcadores de remodelacao ossea e exames bioquimicos gerais foram realizadas. Aferimos tambem peso, altura, indice de massa corporal e porcentagem de gordura, sendo esta ultima medida por absorciometria por dupla emissao de raio X (DERA). Dividimos os pacientes em tres grupos separados de acordo com suas porcentagens de gordura corporea e fornecemos colecalciferol na dose de 7.000 UI por semana por um periodo de 12 semanas. Verificamos que a elevacao da 25(OH)D plasmatica entre os grupos que receberam suplementacao foi semelhante, com aumento medio de 7,46 ng/mL (p<0,05). Com este aumento conseguimos apenas eleva-los da categoria de insufiCiência de vitamina D para a de hipovitaminose. Foi atingido plato dos niveis de 25(OH)D ja com 6 semanas de tratamento. Nao observamos queda nos niveis de PTH nem dos marcadores de remodelacao ossea (OC e CTX-s) ao longo deste periodo. Este estudo mostrou que ha uma elevada prevalencia de insufiCiência de vitamina D nos idosos desta instituicao e que a massa adiposa nao influenciou a elevacao dos niveis de 25(OH)D apos suplementacao, sugerindo nao haver necessidade de adequacao da dose de colecalciferol baseada em parametros de adiposidade
Vitamin D deficiency is responsible for loss of bone mass and increased risk of bone fractures. It has been observed mainly in the elderly and this promoted several studies about vitamin D supplementation in the geriatric population. Currently, fixed doses of cholecalciferol are advised, but since there are few studies evaluating the factors that influence the plasmatic levels of 25-hydroxivitamin D (25(OH)D) following supplementation, we decided to analyse the relationship between plasmatic elevation of 25(OH)D after supplementation and adiposity parameters. We studied a group of 42 homebound elderly over 65 years old (31 women), body mass index (BMI) ranging from 15.62 to 36.68 kg/m2 and aimed to evaluate whether there is a need for adequation of the doses of cholecalciferol administered to this age group according to their adipose mass. Baseline measurements of 25(OH)D, intact parathyroid hormone (PTH), leptin, bone remodelling markers (osteocalcin and Carboxy-terminal fraction of the collagen type 1) and blood chemistry were performed. Weight, height, BMI, and body fat percentage were measured, the latter by double emission X ray absorptiometry. The patients were distributed into three separate groups according to their body fat percentage index and were provided with cholecalciferol 7,000 IU a week for twelve weeks. Elevation in plasmatic levels of 25(OH)D was similar among these groups, averaging 7.46 ng/mL (p<0.05). Noteworthy, this rise only shifted these patients from an insufficiency level to the level of hypovitaminosis. Peak levels of 25(OH)D were attained with only six weeks of treatment. We observed no decrease in both PTH levels and bone remodelling markers levels. This study revealed there is a great prevalence of vitamin D insufficiency in the population of this nursing home and showed that adipose tissue mass does not influence the elevation of the levels of 25(OH)D following vitamin D supplementation, suggesting that there is no need for adequacy of cholecalciferol supplementation based in adiposity parameters.
Vitamin D deficiency is responsible for loss of bone mass and increased risk of bone fractures. It has been observed mainly in the elderly and this promoted several studies about vitamin D supplementation in the geriatric population. Currently, fixed doses of cholecalciferol are advised, but since there are few studies evaluating the factors that influence the plasmatic levels of 25-hydroxivitamin D (25(OH)D) following supplementation, we decided to analyse the relationship between plasmatic elevation of 25(OH)D after supplementation and adiposity parameters. We studied a group of 42 homebound elderly over 65 years old (31 women), body mass index (BMI) ranging from 15.62 to 36.68 kg/m2 and aimed to evaluate whether there is a need for adequation of the doses of cholecalciferol administered to this age group according to their adipose mass. Baseline measurements of 25(OH)D, intact parathyroid hormone (PTH), leptin, bone remodelling markers (osteocalcin and Carboxy-terminal fraction of the collagen type 1) and blood chemistry were performed. Weight, height, BMI, and body fat percentage were measured, the latter by double emission X ray absorptiometry. The patients were distributed into three separate groups according to their body fat percentage index and were provided with cholecalciferol 7,000 IU a week for twelve weeks. Elevation in plasmatic levels of 25(OH)D was similar among these groups, averaging 7.46 ng/mL (p<0.05). Noteworthy, this rise only shifted these patients from an insufficiency level to the level of hypovitaminosis. Peak levels of 25(OH)D were attained with only six weeks of treatment. We observed no decrease in both PTH levels and bone remodelling markers levels. This study revealed there is a great prevalence of vitamin D insufficiency in the population of this nursing home and showed that adipose tissue mass does not influence the elevation of the levels of 25(OH)D following vitamin D supplementation, suggesting that there is no need for adequacy of cholecalciferol supplementation based in adiposity parameters.
Descrição
Citação
CANTO-COSTA, Marcelo Henrique da Silva. Avaliação dos níveis de 25-hidroxivitamina D e parâmetros de adiposidade como determinantes para adequação de suplementação de colecalciferol para idosos institucionalizados. 2004. 78f. Dissertação (Mestrado) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2004.