Effect of diet and lifestyle factors on bone health in postmenopausal women

Health Problems and Disabilities Among the Postmenopausal Saudi Women in Bisha City Receiving Home Care: A Descriptive Cross-Sectional Study

BACKGROUND

Postmenopausal women experience physical and psychological changes that may affect their health status. In Saudi Arabia, where the population of postmenopausal women is increasing, there is a need to examine the health problems and disabilities experienced by this group, particularly those who receive home care. This study aims to identify the common health problems and disabilities experienced by postmenopausal Saudi women in Bisha city who receive home care services.

METHODS

A cross-sectional study in Bisha city, Saudi Arabia, involved 155 postmenopausal women (age 60 years and above) receiving home care services. Data were collected using structured interviews and medical records.

RESULTS

The study found that the most common health problems among postmenopausal women receiving home care were cardiovascular diseases in 85 women (54.84%), diabetes in 85 women (54.84%), and musculoskeletal disorders in 56 women (36.13%). There was a significant association between the number of health problems and disabilities, indicating that women with more health problems were more likely to experience disabilities (p-value ≤ 0.05). The results showed that age (OR=1.56, 95% CI 1.23-1.99, p=0.001), chronic diseases (OR=2.34, 95% CI 1.43-3.84, p=0.001), and lower education level (OR=1.45, 95% CI 1.01-2.08, p=0.045) were significantly associated with the presence of health problems and disabilities among postmenopausal Saudi women receiving home care in Bisha city. However, marital status and employment status were not found to be significant predictors.

CONCLUSION

Postmenopausal women in Bisha city who receive home care services experience a range of health problems and disabilities, particularly related to hypertension, diabetes, and musculoskeletal disorders. The findings of this study can help healthcare providers develop effective interventions and strategies to improve the health outcomes of this population.

Dietary Calcium Intake and Osteoporosis Risk in Arab Adults

Osteoporosis is a major public health concern in Saudi Arabia's aging population. There is particularly limited information on how diet affects bone loss in this ethnic group. The purpose of this study was to examine the association between dietary calcium (Ca) intake and osteoporosis risk in Saudi adults. A total of 1950 patients (416 males and 1534 females) with known risk factors for osteoporosis participated in this cross-sectional study. A short questionnaire (CaQ) was used to assess dietary Ca intakes in patients attending tertiary hospitals in Riyadh City. The prevalence of osteoporosis was 21.3% and was more common in females (93.5%). Patients with osteoporosis were older (p < 0.001) and had lower BMI (p < 0.001). Results showed that the overall mean Ca intake was only 445.1 mg/day (recommended dietary intake of 1300 mg/day). Tea intake (OR = 0.8 95%CI: 0.7-1.0; p = 0.02) and consumption of fish and eggs (OR = 0.9 95%CI: 0.8-1.0; p = 0.01) were significantly associated with a lower risk of osteoporosis. Furthermore, consumption of biscuits, cake and bread slices were significantly associated with higher incidence of osteoporosis (OR = 1.3 95%CI: 1.0-1.5; p = 0.02). In conclusion, extremely low dietary Ca intake was observed among Saudi adults already at risk of osteoporosis. A balanced diet including high amount of Ca, vitamin D and omega-3 fatty acids accompanied by limiting consumption of foods high in saturated fats and glycemic index may be helpful in reducing osteoporosis risk in the Saudi adult population.

Osteoporosis among Postmenopausal Women in Jordan: A National Cross-Sectional Study

Osteoporosis is considered a widespread health problem that affects senior citizens, particularly older women, after the menopause. This national study aimed to estimate the prevalence of osteoporosis among Jordanian postmenopausal women and to determine the association of demographic and nutritional factors, such as calcium and vitamin D supplement intake, with osteoporosis in postmenopausal women. A cross-sectional study was conducted among 884 postmenopausal women aged ≥50 years. A multistage sampling technique was used to select participants from three geographic regions of Jordan (north, middle, and south). The data were collected from the participants by a team of field researchers comprising men and women through a standard questionnaire. The prevalence of osteoporosis was 19.8% among postmenopausal Jordanian women. The study results showed that age (p ˂ 0.001), geographic region (p = 0.019), occupation (p = 0.002), and educational level (p = 0.001) were significantly associated with osteoporosis. Moreover, osteoporosis was significantly associated with calcium and vitamin D supplement intake (p < 0.05). There is a high prevalence of osteoporosis among postmenopausal Jordanian women. Therefore, there is a need to educate women at this age, and probably at an earlier age, to prevent or reduce the development of osteoporosis.

Relationship between bone turnover markers and the heel stiffness index measured by quantitative ultrasound in post-menopausal Japanese women

Background: Osteoporosis in women is a serious health problem. The relationships between biochemical markers of bone turnover and bone mineral density (BMD) in women have been reported, but no study has examined relationships between tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP) and bone mass measured by quantitative ultrasound (QUS) in Japanese post-menopausal women. Aim: To investigate the serum TRACP-5b and BAP levels and to determine their associations with the heel stiffness index measured by QUS in post-menopausal women. Subjects and methods: The subjects were 510 post-menopausal women who were invited to participate in periodic health examinations in 2011-2013 (the Unzen Study). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected and TRACP-5b and BAP levels were measured. Results: Multiple regression analysis showed that a higher log (TRACP-5b) was correlated with a lower stiffness index (p = 0.014) and log (BAP) was not correlated with stiffness index after adjusting for covariates (p = 0.136). Conclusion: Higher rates of bone resorption are associated with a lower stiffness index in Japanese post-menopausal women. These results may indicate that high bone resorption affects bone mass more than bone formation, resulting in a low bone mass.

Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years

We undertook a systematic review and meta-analysis of published papers assessing dietary protein and bone health. We found little benefit of increasing protein intake for bone health in healthy adults but no indication of any detrimental effect, at least within the protein intakes of the populations studied. This systematic review and meta-analysis analysed the relationship between dietary protein and bone health across the life-course. The PubMed database was searched for all relevant human studies from the 1st January 1976 to 22nd January 2016, including all bone outcomes except calcium metabolism. The searches identified 127 papers for inclusion, including 74 correlational studies, 23 fracture or osteoporosis risk studies and 30 supplementation trials. Protein intake accounted for 0-4% of areal BMC and areal BMD variance in adults and 0-14% of areal BMC variance in children and adolescents. However, when confounder adjusted (5 studies) adult lumbar spine and femoral neck BMD associations were not statistically significant. There was no association between protein intake and relative risk (RR) of osteoporotic fractures for total (RR_(random) = 0.94; 0.72 to 1.23, I² = 32%), animal (RR _(random) = 0.98; 0.76 to 1.27, I² = 46%) or vegetable protein (RR _(fixed) = 0.97 (0.89 to 1.09, I² = 15%). In total protein supplementation studies, pooled effect sizes were not statistically significant for LSBMD (total n = 255, MD_(fixed) = 0.04 g/cm² (0.00 to 0.08, P = 0.07), I² = 0%) or FNBMD (total n = 435, MD_(random) = 0.01 g/cm² (-0.03 to 0.05, P = 0.59), I² = 68%). There appears to be little benefit of increasing protein intake for bone health in healthy adults but there is also clearly no indication of any detrimental effect, at least within the protein intakes of the populations studied (around 0.8-1.3 g/Kg/day). More studies are urgently required on the association between protein intake and bone health in children and adolescents.

Vitamin D Intake among Premenopausal Women Living in Jeddah: Food Sources and Relationship to Demographic Factors and Bone Health

BACKGROUND

Saudi women depend on food sources to maintain their serum 25(OH) D concentrations because covering by traditional clothing and time spent indoors limit their sun exposure. Little is known about vitamin D intake and its main food sources in Saudi Arabia. In addition, the association between vitamin D and calcium intake and bone mineral density (BMD) in young women is not well researched.

OBJECTIVES

To assess the adequacy of vitamin D intake among Saudi women as compared to the estimated average requirements (EARs), to identify dietary vitamin D sources, to examine potential determinants of vitamin D intake, and to assess bone health and the association of calcium and vitamin D intake with BMD.

METHODS

This cross-sectional study was conducted in 257 premenopausal women aged 20-50 years in Jeddah, Saudi Arabia. Dietary vitamin D and calcium were assessed by the Semiquantitative Food Frequency Questionnaire. BMD was measured using dual-energy X-ray absorptiometry (DXA) in a subset of women (n=102) at the lumbar spine and femur neck.

RESULTS

Sixty-five percent of women were below the EAR for vitamin D, and 61% fell below the EAR for calcium. Dairy products, supplements, and fish contributed most to vitamin D intake. Increased age was an independent determinant of sufficient vitamin D intake (p < 0.001). The prevalence of osteopenia was 33% in the lumbar spine and 30% in the femur neck. There was a significant positive association between calcium intake and BMD at the lumbar spine (p=0.043) after controlling for body mass index and energy intake. Vitamin D intake was not significantly different between women with low and normal bone mass.

CONCLUSION

Premenopausal women in Jeddah have insufficient vitamin D and calcium intakes. Public health strategies to improve nutrition in young women are needed, and expanding fortification programs to include all dairy products would be useful.

Vitamin D in Saudi Arabia: Prevalence,distribution and disease associations

More than 33 years have passed since the first paper highlighting vitamin D deficiency as a public health concern in Saudi Arabia was published in 1983. Despite "early" detection,it wasn't until the year 2010 where the interest in vitamin D research grew exponentially worldwide and was finally visible in Saudi clinical and academic areas. Since then,many landmark studies have been generated with regards to the physiologic functions of vitamin D,both skeletal and extra-skeletal. This review is limited to the prevalence,distribution A systematic review on the prevalence studies done in KSA from 2011 to 2016 was done and revealed that the prevalence of vitamin D deficiency (<50nmol/l) in Saudi Arabia among different populations (adults,children and adolescents,newborns and pregnant/lactating women) is 81.0% (Confidence Interval 95% 68.0-90.0),in line with most neighboring Gulf countries. Vitamin D deficiency in KSA has been mostly associated with bone and insulin-resistant diseases but limited data are available to prove causality. In conclusion,there is a need to develop local consensus guidelines that will identify candidates for screening,monitoring and treating those who are at most risk for vitamin D deficiency complications.

The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions

Micronutrient deficiencies and inadequacies constitute a global health issue, particularly among countries in the Middle East. The objective of this review is to identify micronutrient deficits in the Middle East and to consider current and new approaches to address this problem. Based on the availability of more recent data, this review is primarily focused on countries that are in advanced nutrition transition. Prominent deficits in folate, iron, and vitamin D are noted among children/adolescents, women of childbearing age, pregnant women, and the elderly. Reports indicate that food fortification in the region is sporadic and ineffective, and the use of dietary supplements is low. Nutrition monitoring in the region is limited, and gaps in relevant information present challenges for implementing new policies and approaches to address the problem. Government-sponsored initiatives are necessary to assess current dietary intakes/patterns, support nutrition education, and to reduce food insecurity, especially among vulnerable population groups. Public-private partnerships should be considered in targeting micronutrient fortification programs and supplementation recommendations as approaches to help alleviate the burden of micronutrient deficiencies and inadequacies in the Middle East.

Bronchial asthma and hypovitaminosis D in Saudi children

BACKGROUND

Asthma, a common lung disease in children, is caused by excessive immune responses to environmental antigens.

OBJECTIVE

Given the immuno-modulatory properties of vitamin D, the aim of the current study was to investigate the relationship between vitamin D levels and markers of asthma severity.

METHODS

This was investigated in a 70 Saudi children with and without asthma and were recruited from the King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, over the period of 11 months (May 2011-April 2012). Childhood asthma control test instrument was employed to assess the level of asthma control among asthmatic patients. Anthropometric measurements were taken and interviewer-administrated questionnaire was completed for all study participants. Pulmonary function test was performed by recording changes in the peak expiratory flow. Venous blood samples were withdrawn for measurements of vitamin D, bone profile, cytokines profile (interleukin-10, tumor necrosis factor-alpha, platelets derived growth factor), and atopy markers (IgE and eosinophil count).

RESULTS

Hypovitaminosis D is highly prevalent among asthmatic children with highly significant increase in several markers of allergy and asthma severity as compared with healthy control children. Significant correlations between several inflammatory and immunological markers and vitamin D levels were also found. Finally, lower 25-hydroxyvitamin D levels were associated with a higher asthma prevalence in multivariable analysis.

CONCLUSION

Our study showed that hypovitaminosis D is highly prevalent in the whole population in addition to a highly significant increase in several markers of allergy and asthma severity among asthmatic children as compared with healthy control children.

Gene-dietary fat interaction, bone mineral density and bone speed of sound in children: a twin study in China

SCOPE

Dietary fat correlates with bone mineral density (BMD). We tested the association between fat intake and BMD, and tested if fat intake modified the degree of genetic influence on BMD and bone speed of sound (SOS).

METHODS AND RESULTS

We included 622 twins aged 7-15 from South China. Data on anthropometry, dietary intake, BMD, and SOS were collected. Quantitative genetic analyses of structural equation models were fit using the Mx statistical package. The within-pair intraclass correlations for BMD in dizygotic twins were nearly half of that for monozygotic twins (intraclass correlations = 0.39 versus 0.70). The heritability of BMD and SOS were 71 and 79%. Phenotypic correlation between fat intake and SOS was significant (r = -0.19, p = 0.04). SOS was negatively correlated with fat intake in boys (r = -0.11, p = 0.05), but not in girls. Full Cholesky decomposition models showed SOS has a strong genetic correlation with fat intake (rA = -0.88, 95% confidence interval = -0.94, 0.01); the environmental correlation between fat intake and SOS was weak (rE = -0.04, 95% confidence interval = -0.20, 0.13). Fat intake modified the additive genetic effects on BMD.

CONCLUSION

Genetic factors explained 71 and 79% of individual variance in BMD and SOS, respectively. Low fat intake counteracts genetic predisposition to low BMD.

Insulin resistance in Saudi postmenopausal women with and without metabolic syndrome and its association with vitamin D deficiency

Background

There is increasing interest in the non-skeletal effects of vitamin D and the relationship between vitamin D deficiency and chronic conditions such as diabetes mellitus. We aimed to investigate the relationship between surrogate indices of insulin resistance (IR), and vitamin D deficiency/insufficiency in postmenopausal Saudi women with and without metabolic syndrome.

Methods

The study population consisted of 300 postmenopausal women aged 46–88 years enrolled consecutively from women attending the Outpatient Clinics of King Abdulaziz University Hospital. Demographic, anthropometric, and biochemical parameters were recorded. Data were analyzed for women with and without metabolic syndrome.

Results

Abdominal obesity, IR, and hypovitaminosis D were highly prevalent within our population sample. Of the components used to define metabolic syndrome; waist circumference, serum triglycerides (TG), high density lipoprotein-cholesterol, and fasting blood glucose (FBG) were significantly related with all surrogate measures of IR. Significant inverse correlations were found between serum vitamin D and serum TG, FBG, and diastolic blood pressure, within the study cohort.

Conclusions

These observations suggest that hypovitaminosis D may be associated with the risk of developing metabolic syndrome. Interrelationships between IR, metabolic syndrome, and hypovitaminosis D are of particular interest in Saudi population, given the high prevalence of these conditions in this region.

Relationship between nutritional profile, measures of adiposity, and bone mineral density in postmenopausal Saudi women

BACKGROUND

Osteoporosis remains a major health problem in all developed countries and is a condition in which several dietary factors have been implicated.

OBJECTIVE

To assess the nutritional status and levels of adiposity of postmenopausal women in relation to bone mineral density.

DESIGN

A cross-sectional study in which dietary intake was estimated by a food frequency questionnaire in 300 Saudi postmenopausal women aged 46-88 years. Bone profile biochemistry (serum calcium, phosphate, parathyroid hormone [PTH], vitamin D) and bone mineral density (BMD) in 3 skeletal sites were determined for all participants.

RESULTS

Overweight and obesity were highly prevalent among the study population. No significant correlation was found between dietary calcium and vitamin D and bone mass at any site. Dietary intake of calcium and vitamin D was significantly less than the recommended levels for a large proportion of the cohort. Energy-adjusted intakes of carbohydrates, fat, protein, and unsaturated fatty acids were associated with BMD in the postmenopausal women. Age, body weight, and residency type were predictors of BMD at all sites. Serum-intact PTH was a predictor of BMD at lumbar spine and femoral neck. Waist : hip ratio (WHR) was a predictor for BMD at femoral neck.

CONCLUSIONS

These results suggest that BMD is influenced by dietary factors other than calcium and vitamin D. However, nondietary factors such as age, WHR, PTH, and body weight may be important determinants of BMD in postmenopausal women.

A secular increase in BMD in Chinese women

Population-based studies have revealed a decline in the incidence of age-adjusted hip fractures in southern Chinese women during the past decade. To determine whether there was a secular change in population characteristics that accounted for this decline, we compared the bone mineral density (BMD) and lifestyle habits of two cohorts of women who were more than 50 years of age and who were recruited from 1995 to 2000 and 2005 to 2010. The BMD levels in the 2005-2010 cohort were significantly higher at the spine and hip and ranged from 3.6 to 17.8% among the different age groups. Additionally, a significantly lower prevalence of subjects with osteoporosis and osteopenia was observed. Longer reproductive years, higher levels of physical activity, higher estradiol and 25(OH) vitamin D levels, and lower alkaline phosphatase levels were found in the 2005-2010 cohort. After adjusting for bone-determining factors, significant differences were detected in the BMD levels at the lumbar spine, femoral neck, and total hip (4.17, 9.02, and 9.34%, respectively) in women >50 years of age but not in women ≤50 years of age. The secular increase in BMD and healthier lifestyles most likely led to the decline in the incidence of age-adjusted fractures.

Influence of education, marital status, occupation, and the place of living on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in women in the RAC-OST-POL Study

The RAC-OST-POL population-based, epidemiological study provided data concerning the influence of education, marital status, occupation, and the place of living (residence) on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in 625 women older than 55 years, all of them recruited from the District of Raciborz in Poland. Their mean age was 66.4 ± 7.8 years. All the women completed a specially designed questionnaire. The skeletal status was assessed by femoral neck (FN) and total hip (TH) densitometry, using a Lunar DPX system (USA). In univariate analyses, taking into consideration the age differences, bone mineralization was dependent on marital status (Z score for FN and TH was significantly higher in widows than in divorcees; p < 0.05), place of residence (better results in rural areas; p < 0.05), and occupation (better in standing than sitting jobs; p < 0.05 for FN Z score and p < 0.01 for TH Z score). The multivariate model allowed us to verify that only place of living and type of occupation had a significant influence on densitometry results. In direct comparison, fracture prevalence seemed to be borderline significantly more common in widows (33.5%) and least common among divorcees (11.8%) (χ(2) = 6.9, df = 3, p = 0.07), but reanalysis performed after age adjustment excluded a true impact of marital status on fracture occurrence. Other factors did not affect fracture occurrence. Some factors influenced the use of medications for osteoporosis: higher level of education was associated with a more frequent use of vitamin D (χ(2) = 8.49, df = 3, p < 0.05) and of hormone replacement therapy (HRT) (χ(2) = 35.7, df = 3, p < 0.00001). HRT was most commonly used by unmarried women (30%) and least commonly by divorcees (11.8%) (χ(2) = 11.7, df = 3, p = 0.01). Vitamin D was more often used among women from the urban area of Raciborz than by those from surrounding rural areas (χ(2) = 9.2, df = 1, p < 0.01). The frequency of use of the three aforementioned medications was associated with the character of occupation. Women with sedentary jobs demonstrated the highest frequency of intake for vitamin D (χ(2) = 9.92, df = 3, p < 0.05) and HRT (χ(2) = 19.48, df = 3, p < 0.001) as well as for other antiresorptive medications (χ(2) = 8.18, df = 3, p < 0.05). We concluded that the results of the epidemiological study demonstrate that both skeletal status and use of antiosteoporotic medications were partially modified by analyzed social factors, whereas fracture prevalence was generally independent from those factors. These data suggest that education, marital status, place of living, and type of occupation may have impacts on implementation of osteoporosis-preventing health programs.

Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes

BACKGROUND

The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide.  

AIM

We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region.

METHODS

Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000-2012; and review articles were used for the period preceding year 2000.

RESULTS

Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30-90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments.

CONCLUSION

Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.

Determinants of serum levels of vitamin D: a study of life-style, menopausal status, dietary intake, serum calcium, and PTH

Background

Low blood levels of vitamin D (25-hydroxy D3, 25OHD3) in women have been associated with an increased risk of several diseases. A large part of the population may have suboptimal 25OHD3 levels but high-risk groups are not well known. The aim of the present study was to identify determinants for serum levels of 25OHD3 in women, i.e. factors such as lifestyle, menopausal status, diet and selected biochemical variables.

Methods

The study was based on women from the Malmö Diet and Cancer Study (MDCS), a prospective, population-based cohort study in Malmö, Sweden. In a previous case–control study on breast cancer, 25OHD3 concentrations had been measured in 727 women. In these, quartiles of serum 25OHD3 were compared with regard to age at baseline, BMI (Body Max Index), menopausal status, use of oral contraceptives or menopausal hormone therapy (MHT) , life-style (e.g. smoking and alcohol consumption), socio-demographic factors, season, biochemical variables (i.e. calcium, PTH, albumin, creatinine, and phosphate), and dietary intake of vitamin D and calcium. In order to test differences in mean vitamin D concentrations between different categories of the studied factors, an ANOVA test was used followed by a t-test. The relation between different factors and 25OHD3 was further investigated using multiple linear regression analysis and a logistic regression analysis.

Results

We found a positive association between serum levels of 25OHD3 and age, oral contraceptive use, moderate alcohol consumption, blood collection during summer/ autumn, creatinine, phosphate, calcium, and a high intake of vitamin D. Low vitamin D levels were associated with obesity, being born outside Sweden and high PTH levels.

Conclusions

The present population-based study found a positive association between serum levels of 25OHD3 and to several socio-demographic, life-style and biochemical factors. The study may have implications e. g. for dietary recommendations. However, the analysis is a cross-sectional and it is difficult to suggest Lifestyle changes as cause- effect relationships are difficult to assess.