Vitamin D Status and Bone Mineral Density is Influenced by Vitamin D Supplementation and Vitamin K1 Intake in Adults with Diabetes and Chronic Kidney Disease
Publication: Canadian Journal of Dietetic Practice and Research
25 October 2016
Abstract
Purpose: Patients with diabetes (DM) and chronic kidney disease (CKD) are at increased risk for suboptimal bone health. The study objective was to investigate the relationships between vitamin D (vitD), vitamin K1 (vitK1), and calcium intake with bone mineral density (BMD) and vitamin D status in an ambulatory population with DM and CKD.
Methods: Adults (age 18–80 years; n = 62) with DM and CKD (stages 1–4) were recruited from the Northern Alberta Renal Program. Primary outcome variables included vitD, vitK1, and calcium intake; serum 25(OH)D, 1,25(OH)2D; and BMD as measured by dual X-ray absorptiometry. Statistical significance was determined at P < 0.05.
Results: Participants met the estimated average requirement or adequate intake for vitD, vitK1, and calcium intake in 73% (n = 45), 66% (n = 39), and 52% (n = 31), respectively, with a combined intake of micronutrient supplementation and diet. Participants had serum 25(OH)D concentrations ≥75 nmol/L (n = 41), normal BMDs (n = 48), and 66% (n = 41/62) were taking vitD supplements (>1000 IU/D). BMD was positively influenced by serum 25(OH)D. However, serum 25(OH) ≥100 nmol/L was associated with lower BMD (absolute and T-scores) for whole-body and spine (P ≤ 0.05). VitK1 intake (≥200 μg/day) was associated with higher whole-body and femoral–neck BMDs (absoluteand T-scores; P ≤ 0.05).
Conclusion: VitD status and BMD in adults with DM and CKD was influenced by vitD supplementation and vitK1 intake.
Résumé
Objectif : Les patients atteints de diabète et de maladie du rein chronique (MRC) présentent un risque accru d’avoir une santé osseuse sous-optimale. L’étude visait à étudier la relation entre l’apport en vitamine D, en vitamine K1 et en calcium et la densité minérale osseuse (DMO) et le statut en vitamine D chez une population ambulatoire atteinte de diabète et de MRC.
Méthodes : Des adultes (âgés de 18 à 80 ans; n = 62) atteints de diabète et de MRC (stades 1 à 4) ont été recrutés du Northern Alberta Renal Program. Les variables dépendantes principales incluaient l’apport en vitamine D, en vitamine K1 et en calcium; les taux sériques de 25(OH)D et de 1,25(OH)2D; et la DMO mesurée à l’aide de l’absorptiométrie à rayon X en double énergie. La signification statistique a été déterminée à P < 0,05.
Résultats : Les participants ont atteint le besoin moyen estimatif ou l’apport suffisant en vitamine D, en vitamine K1 et en calcium à raison de 73 % (n = 45), de 66 % (n = 39) et de 52 % (n = 31), respectivement, avec un apport combiné comprenant la supplémentation en oligo-éléments et l’alimentation. Les participants ont obtenu des taux sériques de 25(OH)D de ≥ 75 nmol/l (n = 41), des DMO normales (n = 48), et 66 % des participants (n = 41/62) prenaient des suppléments de vitamine D (> 1000 IU/jour). La DMO a été influencée de manière positive par le taux sérique de 25(OH)D. Cependant, les taux sériques de 25(OH) ≥ 100 nmol/l étaient associés à une DMO plus faible (absolue et scores T) pour le corps entier et la colonne vertébrale (P ≤ 0,05). L'apport en vitamine K1 (≥ 200 μg/jour) a été associé à des DMO plus élevées pour le corps entier et pour le col fémoral (absolue et scores T; P ≤ 0,05).
Conclusion : Le statut en vitamine D et la DMO chez les adultes atteints de diabète et de MRC étaient influencés par la supplémentation en vitamine D et l’apport en vitamine K1.
Get full access to this article
View all available purchase options and get full access to this article.
Funding: Funding for this project was provided by the Canadian Foundation for Dietetic Practice and Research. Personal funding provided by the G. Woodrow Wirtanen Studentships (MRH, STJ, PL, Alberta Diabetes Institutes, University of Alberta). Doctoral recruitment scholarship (MRH), CIHR MSc Scholarship (STJ), Dietitians of Canada Graduate Award (STJ), Anthony Clinical Nutrition Fellowship (STJ), and Saudi Cultural Bureau (AA) is gratefully acknowledged.
Conflict of interest: None to report.
References
1
Piccoli GB, Vigotti FN, Leone F, Capizzi I, Daidola G, Cabiddu G, et al., Low-protein diets in CKD: how can we achieve them? A narrative, pragmatic review. Clin Kidney J. 2015 Feb;8(1):61–70.
2
Sinha AD and Agarwal R.Chronic renal disease progression: treatment strategies and potassium intake. Semin Nephrol. 2013 May;33(3):290–9.
3
Holden RM, Morton AR, Garland JS, Pavlov A, Day AG, and Booth SL.Vitamins K and D status in stages 3–5 chronic kidney disease. Clin J Am Soc Nephrol. 2010 Apr;5(4):590–7.
4
Pittas AG, Lau J, Hu FB, and Dawson-Hughes B.The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007 Jun;92(6):2017–29.
5
Rucker D, Allan JA, Fick GH, and Hanley DA.Vitamin D insufficiency in a population of healthy western Canadians. CMAJ. 2002 Jun 11;166(12):1517–24.
6
Diaz VA, Mainous AG 3rd, Carek PJ, Wessell AM, and Everett CJ. The association of vitamin D deficiency and insufficiency with diabetic nephropathy: implications for health disparities. J Am Board Fam Med. 2009 Sep–Oct;22(5):521–7.
7
Rucker D, Tonelli M, Coles MG, Yoo S, Young K, and McMahon AW.Vitamin D insufficiency and treatment with oral vitamin D3 in northern-dwelling patients with chronic kidney disease. J Nephrol. 2009 Jan–Feb;22(1):75–82.
8
Sanfelix-Genoves J, Gil-Guillen VF, Orozco-Beltran D, Giner-Ruiz V, Pertusa-Martinez S, Reig-Moya B, et al., Determinant factors of osteoporosis patients’ reported therapeutic adherence to calcium and/or vitamin D supplements: a cross-sectional, observational study of postmenopausal women. Drugs Aging. 2009;26(10):861–9.
9
Hadjidakis DJ, Raptis AE, Sfakianakis M, Mylonakis A, and Raptis SA.Bone mineral density of both genders in Type 1 diabetes according to bone composition. J Diabetes Complications. 2006 Sep–Oct;20(5):302–7.
10
Stipanuk MH and Caudill MA.Biochemical, physiological, and molecular aspects of human nutrition. 3rd ed. St. Louis, MO: Elsevier Saunders; 2013.
11
Kidd PM.Vitamins D and K as pleiotropic nutrients: clinical importance to the skeletal and cardiovascular systems and preliminary evidence for synergy. Altern Med Rev. 2010 Sep;15(3):199–222.
12
Booth SL.Roles for vitamin K beyond coagulation. Annu Rev Nutr. 2009;29:89–110.
13
Iwamoto J, Sato Y, Takeda T, and Matsumoto H.High-dose vitamin K supplementation reduces fracture incidence in postmenopausal women: a review of the literature. Nutr Res. 2009 Apr;29(4):221–8.
14
Senior PA, MacNair L, and Jindal K.Delivery of multifactorial interventions by nurse and dietitian teams in a community setting to prevent diabetic complications: a quality-improvement report. Am J Kidney Dis. 2008 Mar;51(3):425–34.
15
Jindal K, MacNair L, and Senior P.A collaborative approach to diabetes nephropathy prevention. Alta RN. 2005 Oct;61(9):10–1.
16
Hoffmann MR, Senior PA, Jackson ST, Jindal K, and Mager DR.Vitamin D status, body composition and glycemic control in an ambulatory population with diabetes and chronic kidney disease. Eur J Clin Nutr. 2016 Jun;70(6):743–9.
17
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al., National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003 Jul 15;139(2):137–47.
18
Freedman LS, Midthune D, Carroll RJ, Krebs-Smith S, Subar AF, Troiano RP, et al., Adjustments to improve the estimation of usual dietary intake distributions in the population. J Nutr. 2004 Jul;134(7):1836–43.
19
Day N, McKeown N, Wong M, Welch A, and Bingham S.Epidemiological assessment of diet: a comparison of a 7-day diary with a food frequency questionnaire using urinary markers of nitrogen, potassium and sodium. Int J Epidemiol. 2001 Apr;30(2):309–17.
20
Presse N, Shatenstein B, Kergoat MJ, and Ferland G.Validation of a semi-quantitative food frequency questionnaire measuring dietary vitamin K intake in elderly people. J Am Diet Assoc. 2009 Jul;109(7):1251–5.
21
Pritchard JM, Seechurn T, and Atkinson SA.A food frequency questionnaire for the assessment of calcium, vitamin D and vitamin K: a pilot validation study. Nutrients. 2010 Aug;2(8):805–19.
22
Presse N, Payette H, Shatenstein B, Greenwood CE, Kergoat MJ, and Ferland G.A minimum of six days of diet recording is needed to assess usual vitamin K intake among older adults. J Nutr. 2011 Feb;141(2):341–6.
23
USDA Nutrient Database. Available from: http://www.ars.usda.gov/nea/bhnrc/ndl. [cited 2015 Aug 31].
24
Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, and Mager D.Assessing nutritional quality and adherence to the gluten-free diet in children and adolescents with celiac disease. Can J Diet Pract Res. 2015 Jun;76(2):56–63.
25
Canada H.Eating well with Canada’s food guide. Ottawa, ON: Health Canada; 2007.
26
Livingstone MB, Robson PJ, Black AE, Coward WA, Wallace JM, McKinley MC, et al., An evaluation of the sensitivity and specificity of energy expenditure measured by heart rate and the Goldberg cut-off for energy intake: basal metabolic rate for identifying mis-reporting of energy intake by adults and children: a retrospective analysis. Eur J Clin Nutr. 2003 Mar;57(3):455–63.
27
Bland JM and Altman DG.Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;327(8476):307–10.
28
National Institutes of Health. Bone mass measurement: what the numbers mean; 2012 Jan [cited 2016 June 30]. Available from: http://www.niams.nih.gov/health_info/bone/bone_health/bone_mass_measure.asp.
29
Siminoski K, O’Keeffe M, Brown JP, Burrell S, Coupland D, Dumont M, et al., Canadian Association of Radiologists technical standards for bone mineral densitometry reporting. Can Assoc Radiol J. 2013 Nov;64(4):281–94.
30
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al., Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911–30.
31
Mager DR, Qiao J, and Turner J.Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease. Eur J Clin Nutr. 2012 Apr;66(4):488–95.
32
Institute of Medicine FaNB. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press; 2010.
33
Institute of Medicine FaNB. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy of Sciences; 2001.
34
Licata A.Bone density vs bone quality: what’s a clinician to do?Cleve Clin J Med. 2009 Jun;76(6):331–6.
35
Nickolas TL, Leonard MB, and Shane E.Chronic kidney disease and bone fracture: a growing concern. Kidney Int. 2008 Sep;74(6):721–31.
36
Nickolas TL, McMahon DJ, and Shane E.Relationship between moderate to severe kidney disease and hip fracture in the United States. J Am Soc Nephrol. 2006 Nov;17(11):3223–32.
37
Ensrud KE, Lui LY, Taylor BC, Ishani A, Shlipak MG, Stone KL, et al., Renal function and risk of hip and vertebral fractures in older women. Arch Intern Med. 2007 Jan 22;167(2):133–9.
38
Fried LF, Biggs ML, Shlipak MG, Seliger S, Kestenbaum B, Stehman-Breen C, et al., Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol. 2007 Jan;18(1):282–6.
39
Booth SL, Broe KE, Gagnon DR, Tucker KL, Hannan MT, McLean RR, et al., Vitamin K intake and bone mineral density in women and men. Am J Clin Nutr. 2003 Feb;77(2):512–6.
40
Booth SL, Tucker KL, Chen H, Hannan MT, Gagnon DR, Cupples LA, et al., Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Am J Clin Nutr. 2000 May;71(5):1201–8.
41
Subar AF, Dodd KW, Guenther PM, Kipnis V, Midthune D, McDowell M, et al., The food propensity questionnaire: concept, development, and validation for use as a covariate in a model to estimate usual food intake. J Am Diet Assoc. 2006 Oct;106(10):1556–63.
42
Fowke JH, Schlundt D, Gong Y, Jin F, Shu XO, Wen W, et al., Impact of season of food frequency questionnaire administration on dietary reporting. Ann Epidemiol. 2004 Nov;14(10):778–85.
43
Sokoll LJ, Booth SL, O’Brien ME, Davidson KW, Tsaioun KI, and Sadowski JA.Changes in serum osteocalcin, plasma phylloquinone, and urinary gamma-carboxyglutamic acid in response to altered intakes of dietary phylloquinone in human subjects. Am J Clin Nutr. 1997 Mar;65(3):779–84.
44
Elliott MJ, Booth SL, Hopman WM, and Holden RM.Assessment of potential biomarkers of subclinical vitamin K deficiency in patients with end-stage kidney disease. Can J Kidney Health Dis. 2014;1:13.
45
Takeda E, Yamamoto H, Yamanaka-Okumura H, and Taketani Y.Increasing dietary phosphorus intake from food additives: potential for negative impact on bone health. Adv Nutr. 2014 Jan;5(1):92–7.
46
Mangano KM, Sahni S, and Kerstetter JE.Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Curr Opin Clin Nutr Metab Care. 2014 Jan;17(1):69–74.
47
Castiglioni S, Cazzaniga A, Albisetti W, and Maier JA.Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients. 2013 Aug;5(8):3022–33.
48
Mager DR, Jackson ST, Hoffmann MR, Jindal K, and Senior PA.Vitamin D supplementation and bone health in adults with diabetic nephropathy: the protocol for a randomized controlled trial. BMC Endocr Disord. 2014;14:66.
Information & Authors
Information
Published In
Canadian Journal of Dietetic Practice and Research
Volume 78 • Number 1 • March 2017
Pages: 11 - 19
History
Version of record online: 25 October 2016
Copyright
© 2017.
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
Michelle R.Hoffmann, Peter A.Senior, Stephanie T.Jackson, GuylaineFerland, NancyPresse, KailashJindal, PingLi, Abeer S.Alzaben, and Diana R.Mager. 2017. Vitamin D Status and Bone Mineral Density is Influenced by Vitamin D Supplementation and Vitamin K1 Intake in Adults with Diabetes and Chronic Kidney Disease. Canadian Journal of Dietetic Practice and Research.
78(1): 11-19. https://doi.org/10.3148/cjdpr-2016-023
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
There are no citations for this item
View Options
Get Access
Login options
Check if you access through your login credentials or your institution to get full access on this article.
Subscribe
Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research
