Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers

BMC Pregnancy and Childbirth

Monica Löfvander²  Yngve Bergqvist¹  Paul Kalliokoski¹ 

[1] Center for Clinical Research Dalarna, Falun, Sweden;Center of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

关键词: Pregnancy;    Somalia;    Primary care;    Physical performance;    Clinical observation;    Grip strength;    Ultraviolet B radiation;    25(OH)D;    Vitamin D;   

Others  :  1131883
DOI  :  10.1186/1471-2393-13-237

 received in 2013-02-07, accepted in 2013-12-12,  发布年份 2013

【 摘 要 】

Background

Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH)D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).

Methods

Women (n=123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60° N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10–24, 25–49, 50–74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH)D categories. Undetectable values (<10 nmol/L) were replaced with ‘9’ in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH)D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.

Results

Somali participants (35%) had 25(OH)D levels of <10 nmol/L, and 90% had <25 nmol/L; 10% of Swedish participants had <25 nmol/L of 25(OH)D, and 54% had <50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167–246) vs. median 316 N (inter-quartile range 278–359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH)D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH)D levels (B 0.94, p=0.013) together with Somali birth (B −63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).

Conclusions

Many Somali women had undetectable/severely low 25(OH)D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH)D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.

【 授权许可】

   
2013 Kalliokoski et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Clemens TL, Adams JS, Henderson SL, Holick MF: Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1982, 1(8263):74-76.
• [2]Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ: Athletic performance and vitamin D. Med Sci Sports Exerc 2009, 41(5):1102-1110.
• [3]Webb AR, Kline L, Holick MF: Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunradiaion in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988, 67(2):373-378.
• [4]Maxwell SM, Salah SM, Bunn JE: Dietary habits of the Somali population in Liverpool, with respect to foods containing calcium and vitamin D: a cause for concern? J Hum Nutr Diet 2006, 19(2):125-127.
• [5]Souberbielle JC: Vitamin D. 1st edition. Torino: SEEd Medical Publishers srl. In collaboration with Diasorin S.p.A; 2011.
• [6]Speeckaert M, Huang G, Delanghe JR, Taes YE: Biological and clinical aspects of the vitamin D binding protein (Gc-globulin) and its polymorphism. Clin Chim Acta 2006, 372(1–2):33-42.
• [7]Houston DK, Cesari M, Ferrucci L, Cherubini A, Maggio D, Bartali B, Johnson MA, Schwartz GG, Kritchevsky SB: Association between vitamin D status and physical performance: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2007, 62(4):440-446.
• [8]Mosekilde L: Vitamin D and the elderly. Clin Endocrinol (Oxf) 2005, 62(3):265-281.
• [9]Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen H, Charles P, Eriksen EF: Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 2000, 66(6):419-424.
• [10]Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE: The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev 2013, 34(1):33-83.
• [11]Grundberg E, Brandstrom H, Ribom EL, Ljunggren O, Mallmin H, Kindmark A: Genetic variation in the human vitamin D receptor is associated with muscle strength, fat mass and body weight in Swedish women. Eur J Endocrinol 2004, 150(3):323-328.
• [12]Visser M, Deeg DJ, Lips P: 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.
• [13]Sato Y, Iwamoto J, Kanoko T, Satoh K: Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovascular diseases 2005, 20(3):187-192.
• [14]Stockton KA, Mengersen K, Paratz JD, Kandiah D, Bennell KL: Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int 2011, 22(3):859-871.
• [15]Houston DK, Tooze JA, Neiberg RH, Hausman DB, Johnson MA, Cauley JA, Bauer DC, Cawthon PM, Shea MK, Schwartz GG, et al.: 25-hydroxyvitamin D status and change in physical performance and strength in older adults: the Health, Aging, and Body Composition Study. Am J Epidemiol 2012, 176(11):1025-1034.
• [16]Pfeifer M, Begerow B, HW M: Vitamin D and muscle function. Osteoporos Int 2002, 13(3):187-194.
• [17]Gerdhem P, Ringsberg KA, Obrant KJ, K. A: Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 2005, 16(11):1425-1431.
• [18]Verreault R, Semba RD, Volpato S, Ferrucci L, Fried L, Guralnik JM: Low serum vitamin d does not predict new disability or loss of muscle strength in older women. J Am Geriatr Soc 2002, 50(5):912-917.
• [19]Pfeifer M, Begerow B, Minne HW, Schlotthauer T, Pospeschill M, Scholz M, Lazarescu AD, Pollahne W: 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.
• [20]Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B: Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006, 84(1):18-28.
• [21]Le Goaziou MF, Contardo G, Dupraz C, Martin A, Laville M, Schott-Pethelaz AM: Risk factors for vitamin D deficiency in women aged 20–50 years consulting in general practice: a cross-sectional study. Eur J Gen Pract 2011, 17(3):146-152.
• [22]Robinson CJ, Wagner CL, Hollis BW, Baatz JE, Johnson DD: Association of maternal vitamin D and placenta growth factor with the diagnosis of early onset severe preeclampsia. Am J Perinatol 2013, 30(3):167-172.
• [23]Hollis BW, Wagner CL: Vitamin D and pregnancy: skeletal effects, nonskeletal effects, and birth outcomes. Calcif Tissue Int 2013, 92(2):128-139.
• [24]Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA: Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One 2008, 3(11):e3753.
• [25]Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM: Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 2007, 92(9):3517-3522.
• [26]Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF: Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab 2009, 94(3):940-945.
• [27]Scholl TO, Chen X, Stein P: Maternal vitamin D status and delivery by cesarean. Nutrients 2012, 4(4):319-330.
• [28]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.
• [29]Lapillonne A: Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Med Hypotheses 2010, 74(1):71-75.
• [30]Felton DJ, Stone WD: Osteomalacia in asian immigrants during pregnancy. Br Med J 1966, 1(5502):1521-1522.
• [31]Sääf M, Fernell E,FK, Barnevik-Olsson M, Gustafsson S,GB: Severe vitamin D deiciency in pregnant women of Somali origin living in Sweden. Acta Paediatr 2011, 100:612-614.
• [32]Laursen B, Moller H: Unintentional injuries in children of Danish and foreign-born mothers. Scand J Public Health 2009, 37(6):577-583.
• [33]Janson S, Schyllander J, Hansson C, Eriksson UB: Children with a single parent are a risk group for drowning. Also immigrant children from the Middle East and Iran are at risk according to a descriptive study. Lakartidningen 2010, 107(24–25):1618-1622.
• [34]Svensson H, Kalhor S, Larsson A: Burns are frequent among immigrant children. Lakartidningen 1996, 93(44):3905-3906.
• [35]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.
• [36]Svensson E, Waling K, Hager-Ross C: Grip strength in children: test-retest reliability using Grippit. Acta Paediatr 2008, 97(9):1226-1231.
• [37]Ekdahl C, Jarnlo GB, Andersson SI: Standing balance in healthy subjects: Evaluation of a quantitative test battery on a force platform. Scand J Rehabil Med 1989, 21(4):187-195.
• [38]Humble M: Vitamin D deficiency probably more common than earlier apprehended. Prevention and treatment could result in unexpected public health effects. Läkartidningen 2007, 104(11):853-857.
• [39]Thuesen B, Husemoen L, Fenger M, Jakobsen J, Schwarz P, Toft U, Ovesen L, Jorgensen T, Linneberg A: Determinants of vitamin D status in a general population of Danish adults. Bone 2012, 50(3):605-610.
• [40]Cavalier E, Delanaye P, Morreale A, Carlisi A, Mourad I, Chapelle JP, Emonts P: Vitamin D deficiency in recently pregnant women. Rev Med Liege 2008, 63(2):87-91.
• [41]van der Meer IM, Karamali NS, Boeke AJ, Lips P, Middelkoop BJ, Verhoeven I, Wuister JD: High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands. Am J Clin Nutr 2006, 84(2):350-353. quiz 468–359
• [42]Madar AA, Klepp KI, Meyer HE: Effect of free vitamin D(2) drops on serum 25-hydroxyvitamin D in infants with immigrant origin: a cluster randomized controlled trial. Eur J Clin Nutr 2009, 63(4):478-484.
• [43]Hjorth M, Kloster S, Girma T, Faurholt-Jepsen D, Andersen G, Kaestel P, Brage S, Friis H: Level and intensity of objectively assessed physical activity among pregnant women from urban Ethiopia. BMC Pregnancy Childbirth 2012, 12(1):154. BioMed Central Full Text
• [44]Gaggero M, Mariani L, Guarino R, Patrucco G, Ballardini G, Boscardini L, Barbaglia M, Bello L, Guala A: Vitamin D at term of pregnancy and during lactation in white and black women living in Northern Italy. Minerva Ginecol 2010, 62(2):91-96.
• [45]Grant WB, Holick MF: Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev 2005, 10(2):94-111.
• [46]Hollis BW: Measuring 25-hydroxyvitamin D in a clinical environment: challenges and needs. Am J Clin Nutr 2008, 88(2):507S-510S.
• [47]Lai JKC, Lucas RM, Clements MS, Harrison SL, Banks E: Assessing vitamin D status: Pitfalss for the unwary. Mol Nutr Food Res 2010, 54:1062-1071.
• [48]Sundquist J: Migration, equality and access to health care services. J Epidemiol Community Health 2001, 55:691-692.