Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency: a before-and-after treatment study

Paul Kalliokoski, Nils Rodhe, Yngve Bergqvist, Monica Löfvander, Paul Kalliokoski, Nils Rodhe, Yngve Bergqvist, Monica Löfvander

Abstract

Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.

Methods: A before- and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD ≤50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes;no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (<10 nmol/L) were replaced with '9' in statistic calculations.

Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0.001). Intake of number of tablets predicted increased grip strength (B 0.067, 95%CI 0.008-0.127, p = 0.027). One tablet daily (>300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).

Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.

Trial registration: ClinicalTrials.gov Identifier: NCT02922803 . Date of registration: September 28, 2016.

Keywords: Adherence; Grip strength; Multicultural care; Physical performance; Pregnancy; Somalia; Vitamin D.

Figures

Fig. 1
Fig. 1
Scatter plot for total tablet intake and change in grip strength (M-max grip, measured in Newton [N]) from baseline to Time II (10-month follow-up) for the target group (TG) women, n = 46. Spearman’s rho 0.32, p = 0.032. M-max grip was mean maximal grip held for 10 s

References

    1. Kalliokoski P, Bergqvist Y, Löfvander M. Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers. BMC Pregnancy Childbirth. 2013;13:j. doi: 10.1186/1471-2393-13-237.
    1. Hoppeler H, Fluck M. Normal mammalian skeletal muscle and its phenotypic plasticity. J Exp Biol. 2002;205(Pt 15):2143–2152.
    1. Ferrando AA, Lane HW, Stuart CA, Davis-Street J, Wolfe RR. Prolonged bed rest decreases skeletal muscle and whole body protein synthesis. Am J Physiol. 1996;270(4 Pt 1):E627–E633.
    1. Krogh-Madsen R, Thyfault JP, Broholm C, Mortensen OH, Olsen RH, Mounier R, et al. A 2-weeks reduction of ambulatory activity attenuates peripheral insulin sensitivity. J Appl Physiol (1985) 2010;108(5):1034–1040. doi: 10.1152/japplphysiol.00977.2009.
    1. Visser M, Deeg DJ, Lips P, Longitudinal Aging Study A Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab. 2003;88(12):5766–5772. doi: 10.1210/jc.2003-030604.
    1. Lips P. Which circulating level of 25-hydroxyvitamin D is appropriate? J Steroid Biochem Mol Biol. 2004;89–90(1–5):611–614. doi: 10.1016/j.jsbmb.2004.03.040.
    1. Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000;66(6):419–424. doi: 10.1007/s002230010085.
    1. Pfeifer M, Begerow B, Minne HW. Vitamin D and muscle function. Osteoporos Int. 2002;13(3):187–194. doi: 10.1007/s001980200012.
    1. Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol. 2010;6(10):550–561. doi: 10.1038/nrendo.2010.146.
    1. Gunnarsdottir I. Nutrition in pregnancy and lactation. In Uppsala. 2008;3–11.
    1. Nordenskiold UM, Grimby G. Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol. 1993;22(1):14–19. doi: 10.3109/03009749309095105.
    1. Vasbinder E, Dahhan N, Wolf B, Zoer J, Blankman E, Bosman D, et al. The association of ethnicity with electronically measured adherence to inhaled corticosteroids in children. Eur J Clin Pharmacol. 2013;69(3):683–690. doi: 10.1007/s00228-012-1380-9.
    1. Santibanez M, Paz-Zulueta M, Ruiz M, Castro I, Llorca J. Factors associated with lack of adherence to antenatal care in African immigrant women and Spanish women in northern Spain: the role of social risk factors in combination with language proficiency. Midwifery. 2015;31(1):61–67. doi: 10.1016/j.midw.2014.05.012.
    1. Mytton J, Frater AP, Oakley G, Murphy E, Barber MJ, Jahfar S. Vitamin D deficiency in multicultural primary care: a case series of 299 patients. Br J Gen Pract. 2007;57(540):577–579.
    1. Kazemi A, Sharifi F, Jafari N, Mousavinasab N. High prevalence of vitamin D deficiency among pregnant women and their newborns in an Iranian population. J Womens Health (Larchmt) 2009;18(6):835–839. doi: 10.1089/jwh.2008.0954.
    1. Sääf M, Fernell E, Kristiansson F, Barnevik Olsson M, Gustafsson SA, Bågenholm G. Severe vitamin D deiciency in pregnant women of Somali origin living in Sweden. Acta Paediatr. 2011;100:612–614. doi: 10.1111/j.1651-2227.2011.02134.x.
    1. van der Meer IM, Karamali NS, Boeke AJ, Lips P, Middelkoop BJ, Verhoeven I, et al. High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands. Am J Clin Nutr. 2006;84(2):350–353.
    1. Das G, Crocombe S, McGrath M, Berry JL, Mughal MZ. Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child. 2006;91(7):569–572. doi: 10.1136/adc.2005.077974.
    1. Song SJ, Zhou L, Si S, Liu J, Zhou J, Feng K, et al. The high prevalence of vitamin D deficiency and its related maternal factors in pregnant women in Beijing. PLoS One. 2013;8(12):e85081. doi: 10.1371/journal.pone.0085081.
    1. Thuesen B, Husemoen L, Fenger M, Jakobsen J, Schwarz P, Toft U, et al. Determinants of vitamin D status in a general population of Danish adults. Bone. 2012;50(3):605–610. doi: 10.1016/j.bone.2011.12.016.
    1. Björk A, Andersson A, Johansson G, Bjorkegren K, Bardel A, Kristiansson P. Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women. BMC Fam Pract. 2013;14:129. doi: 10.1186/1471-2296-14-129.
    1. von Hurst PR, Beck KL. Vitamin D and skeletal muscle function in athletes. Curr Opin Clin Nutr Metab Care. 2014;17(6):539–545. doi: 10.1097/MCO.0000000000000105.
    1. Durup D, Jorgensen HL, Christensen J, Tjonneland A, Olsen A, Halkjaer J, et al. A Reverse J-Shaped Association Between Serum 25-Hydroxyvitamin D and Cardiovascular Disease Mortality: The CopD Study. J Clin Endocrinol Metab. 2015;100(6):2339–2346. doi: 10.1210/jc.2014-4551.
    1. Manson JE, Bassuk SS. Vitamin D research and clinical practice: at a crossroads. JAMA. 2015;313(13):1311–1312. doi: 10.1001/jama.2015.1353.
    1. Lai JKC, et al. Assessing vitamin D status: Pitfalls for the unwary. Mol Nutr Food Res. 2010;54:1062–1071.
    1. Pfeifer M, Begerow B, Minne HW, Schlotthauer T, Pospeschill M, Scholz M, et al. Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes. 2001;109(2):87–92. doi: 10.1055/s-2001-14831.
    1. Michael YL, Smit E, Seguin R, Curb JD, Phillips LS, Manson JE. Serum 25-hydroxyvitamin D and physical performance in postmenopausal women. J Womens Health (Larchmt) 2011;20(11):1603–1608. doi: 10.1089/jwh.2010.2606.
    1. Mazahery H, Stonehouse W, von Hurst PR. The effect of monthly 50,000 IU or 100,000 IU vitamin D supplements on vitamin D status in premenopausal Middle Eastern women living in Auckland. Eur J Clin Nutr. 2015;69(3):367–372. doi: 10.1038/ejcn.2014.264.
    1. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77(1):204–10.
    1. Rejnmark L. Effects of vitamin d on muscle function and performance: a review of evidence from randomized controlled trials. Ther Adv Chronic Dis. 2011;2(1):25–37. doi: 10.1177/2040622310381934.
    1. Janssen HC, Emmelot-Vonk MH, Verhaar HJ, van der Schouw YT. Vitamin D and muscle function: is there a threshold in the relation? J Am Med Dir Assoc. 2013;14(8):627. doi: 10.1016/j.jamda.2013.05.012.
    1. Dhanwal DK, Dharmshaktu P, Gautam VK, Gupta N, Saxena A. Hand grip strength and its correlation with vitamin D in Indian patients with hip fracture. Arch Osteoporos. 2013;8(1–2):158. doi: 10.1007/s11657-013-0158-8.
    1. Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. 2009;20(2):315–322. doi: 10.1007/s00198-008-0662-7.
    1. Knutsen KV, Madar AA, Lagerlov P, Brekke M, Raastad T, Stene LC, et al. Does vitamin D improve muscle strength in adults? A randomized, double-blind, placebo-controlled trial among ethnic minorities in Norway. J Clin Endocrinol Metab. 2014;99(1):194–202. doi: 10.1210/jc.2013-2647.
    1. Goswami R, Vatsa M, Sreenivas V, Singh U, Gupta N, Lakshmy R, et al. Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double-blind randomized controlled clinical trial. J Clin Endocrinol Metab. 2012;97(12):4709–4716. doi: 10.1210/jc.2012-2340.
    1. Annweiler C, Schott AM, Berrut G, Fantino B, Beauchet O. Vitamin D-related changes in physical performance: a systematic review. J Nutr Health Aging. 2009;13(10):893–898. doi: 10.1007/s12603-009-0248-x.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren