ERIC Number: EJ864409
Record Type: Journal
Publication Date: 2009-Dec
Abstractor: As Provided
Reference Count: 36
Vitamin D Status and Optimal Supplementation in Institutionalized Adults with Intellectual Disability
Kilpinen-Loisa, P.; Arvio, M.; Ilvesmaki, V.; Makitie, O.
Journal of Intellectual Disability Research, v53 n12 p1014-1023 Dec 2009
Background: Adults with intellectual disability (ID) have several risk factors for osteoporosis. Feeding problems with consequent nutritive deficiencies, and lack of sunshine exposure may lead to vitamin D deficiency. The purpose of this study was to evaluate vitamin D status in adults with ID living in nursing homes and to compare two different means to administer vitamin D in adults with ID. Methods: The study included 138 adults (95 males and 43 females) with ID living in nursing homes of Paajarvi Inter-Municipal Association. Clinical data on the etiology and severity of ID, other illnesses, medications, anthropometry and fractures during the preceding 5 years were collected from medical records. The participants were alternately allocated to receive vitamin D3 either per orally 800 IU daily for 6 months (PO group, n = 72) or as a single intramuscular injection of 150 000 IU (IM group, n = 66). Blood samples were obtained at baseline and at 6 months for parameters of calcium homeostasis, including serum concentrations of 25-hydroxyvitamin D (S-25-OHD) and parathyroid hormone (P-PTH). Results: At baseline, the mean S-25-OHD was low, 40 nmol/L in the PO group and 41 nmol/L in the IM group. The low vitamin D levels were associated with secondary hyperparathyroidism in 17%. At 6 months the mean S-25-OHD was 82 nmol/L in the PO group (P less than 0.001 for the difference from baseline) and 62 nmol/L in the IM group (P less than 0.001). P-PTH decreased in both groups: from 51 ng/L to 33 ng/L in the PO group (P less than 0.001) and from 54 ng/L to 34 ng/L in the IM group (P less than 0.001). With daily dosing (800 IU/day) the recommended level (greater than 80 nmol/L) was attained in 42%, but with intramuscular dose only in 12%. S-25-OHD was greater than 100 nmol/L in 14 participants in the PO group and in one participant in the IM group; these high values were associated with hypercalcemia in two and hyperphosphatemia in six participants. Participants with S-25-OHD greater than 100 nmol/L at 6 months were lighter (51.9 kg vs. 67.5 kg, P = 0.002) and had smaller body mass index than participants with lower S-25-OHD (20.5 kg/m[superscript 2] and 24.4 kg/m[superscript 2], P = 0.017). Conclusions: Vitamin D insufficiency was common in adults with ID living in nursing homes. Both oral and intramuscular administrations of vitamin D3 improved vitamin D status without adverse effects. The treatment response at 6 months was better in the PO group. High-dose intramuscular vitamin D3 injections may be a convenient way to maintain sufficient vitamin D status in adults with ID but further studies are needed to establish the optimal dose and interval as well as subsequent potential health benefits in these patients. Based on this study, vitamin D supplementation with per oral 800 IU/day is recommended to all adults with ID living in nursing homes.
Descriptors: Body Composition, Mental Retardation, At Risk Persons, Patients, Nursing Homes, Nutrition, Institutionalized Persons, Adults, Foreign Countries, Intervention, Program Effectiveness, Symptoms (Individual Disorders)
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Publication Type: Journal Articles; Reports - Research
Education Level: N/A
Authoring Institution: N/A
Identifiers - Location: Finland