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Vitamin D is associated with lower limb muscle strength and grip strength in Middle Eastern- and African-born immigrants in Sweden
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0003-2475-7131
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
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2018 (English)In: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 59, p. 29-35Article in journal (Refereed) Published
Abstract [en]

There is increasing evidence that vitamin D status is associated with muscle function. Vitamin D deficiency is common in immigrants. We hypothesized that there was a positive association between vitamin D status and muscle strength in immigrants. The aim of this study was to examine associations between vitamin D status and muscle strength in an immigrant population in Sweden. All immigrants aged 25-65 years, born in 9 African or Middle East countries, and living in a district in Umeå (n = 1306) were invited. A total of 111 men and 105 women (16.5%) completed the study. Lower limb muscle strength was examined using a standardized muscle function indices of muscle strength. Grip strength was examined using a JAMAR hand dynamometer. Serum 25-hydroxyvitamin D [25(OH)D] was measured using liquid chromatography–tandem mass spectrometry. The analyses were adjusted for sex, age, height, body mass index, years since immigration, 25(OH)D, vitamin D deficiency, physical activity, and medical and socioeconomic factors. Twelve percent of the immigrants had vitamin D deficiency [25(OH)D levels <25 nmol/L]. In multivariable analyses, reduced lower limb muscle strength remained linearly associated with lower 25(OH)D concentrations (P = .008) and weaker grip strength remained associated with vitamin D deficiency (P = .022) after adjustments. The association between vitamin D deficiency and reduced lower limb muscle strength did not reach statistical significance (P = .052). The results demonstrate that vitamin D deficiency and low 25(OH)D concentrations were associated with muscle weakness in immigrants.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 59, p. 29-35
National Category
General Practice
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-147571DOI: 10.1016/j.nutres.2018.07.009ISI: 000451792500003PubMedID: 30442230OAI: oai:DiVA.org:umu-147571DiVA, id: diva2:1204636
Note

First published in thesis in manuscript form.

Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-12-19Bibliographically approved
In thesis
1. Vitamin D deficiency in Northern Sweden: a cross-sectional study of an immigrant population at latitude 63° N, including an open partially randomized, controlled trial studying the effect of supplementation with different doses of cholecalciferol
Open this publication in new window or tab >>Vitamin D deficiency in Northern Sweden: a cross-sectional study of an immigrant population at latitude 63° N, including an open partially randomized, controlled trial studying the effect of supplementation with different doses of cholecalciferol
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Vitamin D is a prohormone that plays a key role in the calcium and phosphate balance and has physiological functions throughout the entire body. Vitamin D is supplied by exposure to ultraviolet light or by food. The prevalence of vitamin D deficiency in immigrants in Northern Sweden was unknown. There was no consensus on how to define or treat vitamin D deficiency and no pure preparations of cholecalciferol available in Sweden.

Aims: To study the prevalence and determinants of vitamin D deficiency in immigrants of African and Middle Eastern origin, to examine associations between vitamin D status and muscle strength, anxiety, depression and quality of life, and to determine the effect of supplementation with cholecalciferol on 25-hydroxyvitamin D3 [25(OH)D] and vitamin D status.

Methods: 1. A cross-sectional, population-based study. Immigrants ages 25-65 from Africa and the Middle East (n=1306) living in Umeå, Sweden, were invited to participate. A total of 111 men and 106 women (16.5%) participated. 25(OH)D was measured by LC-MsMs. Anthropometry, medical, socioeconomic and lifestyle data was registered. Examinations: lower limb muscle strength, grip strength, HAD, health-related quality of life (QoL) 2. An open, partially randomized, controlled trial including immigrants from Africa or the Middle East, 192 subjects screened, 160 included and 147 completed the study. Intervention: cholecalciferol 12±2 weeks, 4 parallel groups; Group 1: 25(OH)D <25nmol/L: 10000 IU/d, Groups 2a and 2b: 25(OH)D 25-49 nmol/L: 2000 IU/d or 2000 IU/w, Group 3: 25(OH)D 50-74 nmol/L: 2000 IU/d.

Results: Twelve percent of the immigrants showed a vitamin D deficiency (25(OH)D ˂25 nmol/L) and 73 % showed 25(OH)D ˂50 nmol/L. Vitamin D deficiency was twice as common in African immigrants as in the Middle Eastern group. Vitamin D deficiency was associated with intake of fatty fish less than once a week, absence of travel abroad and use of long-sleeved clothing in summer. Lower limb muscle strength was associated with 25(OH)D levels and weaker grip strength was associated with vitamin D deficiency. Vitamin D deficiency was not associated with anxiety, depression or QoL in the total immigrant population. In Middle Eastern women, in whom prevalence of anxiety was higher, anxiety was associated with 25(OH)D ≤49 nmol/L. Oral cholecalciferol was effective in increasing 25(OH)D. At study end, 100% in Group 1, 89% in Group 2a, 55% in Group 2b and 96% in Group 3 reached adequate vitamin D status (25(OH)D ˃50 nmol/L). In Group 1; 62 % reached 25(OH)D ≥125 nmol/L.

Conclusions: Vitamin D deficiency and insufficiency was common in the immigrant group and no difference was shown between men and women. A diet including a high intake of fatty fish was most important in avoiding vitamin D deficiency. Vitamin D status was associated with muscle strength in all immigrants. Vitamin D deficiency was not associated with anxiety, depression or QoL in the immigrants. In female immigrants from the Middle East, anxiety was associated with 25(OH)D levels ≤49 nmol/L. Supplementation with cholecalciferol 2000 IU/day for three months was safe in healthy individuals with initial 25(OH)D 25-49 nmol/L, but monitoring is warranted since 11 % did not attain sufficient vitamin D status. The dose 10 000 IU/day in patients with initial 25(OH)D <25 nmol/L was unnecessarily high.

Place, publisher, year, edition, pages
Umeå: Umeå University, Department of Public Health and Clinical Medicine, 2018. p. 86
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1964
Keywords
vitamin D deficiency, 25-hydroxyvitamin D, cross-sectional study, immigrant, muscle strength, grip strength, anxiety, depression, health related quality of life, clinical trial, cholecalciferol
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-147575 (URN)978-91-7601-878-1 (ISBN)
Public defence
2018-06-01, Sal 933, målpunkt B, 9 tr, Norrlands Universitetssjukhus, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
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Available from: 2018-05-09 Created: 2018-05-08 Last updated: 2018-11-09Bibliographically approved

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Granlund, LenaNorberg, MargaretaRamnemark, AnnaAndersson, ChristerLindkvist, MarieFhärm, Eva

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