Mild vitamin D deficiency and secondary hyperparathyroidism in nursing home patients receiving adequate dietary vitamin D.
OBJECTIVE
To compare the vitamin D metabolite and nutritional status of institutionalized elderly males with a noninstitutionalized control group.


METHODS
Case-control study.


METHODS
Veterans Administration Medical Center Nursing Home (NH) in Richmond, Virginia.


METHODS
Fifty-seven consecutive nursing home subjects were screened. After excluding blacks, those receiving anticonvulsants, glucocorticoids, or vitamin supplements, and those with liver or renal failure (creatinine greater than 1.5 mg/dL), 35 subjects were enrolled, and 22 completed the study. The noninstitutionalized control group (n = 18) consisted of consecutive volunteers, meeting the above criteria, from either a senior citizen group or a geriatric clinic.


RESULTS
The serum 25-hydroxy-vitamin D level in the NH residents was significantly lower than in community dwellers (17.4 +/- 5.2 ng/mL vs 31.2 pg/mL +/- 8.0 ng/mL, P less than 0.0001). No significant difference was demonstrated in 1,25-dihydroxyvitamin D levels (36.5 pg/mL +/- 10.5 in NH residents vs 42.0 pg/mL +/- 11.1 in controls). In the NH group PTH levels were inversely correlated with 25 OHD levels (P less than 0.008) and positively correlated with length of stay in the NH (P less than 0.016). There was no significant seasonal variation in vitamin D metabolite levels in the NH group. In the NH patients, the mean dietary intake of vitamin D was 232 +/- 378 mg/day and of calories was 1811 +/- 447 kcal/day.


CONCLUSIONS
Despite apparently adequate calories, calcium, and vitamin D intake, hypovitaminosis D with compensatory PTH elevations occurs, regardless of season, in the nursing home population.
McMurtry
C T
CT
Section of Geriatrics, McGuire VA Medical Center, Richmond, VA 23249.
Young
S E
SE
Downs
R W
RW
Adler
R A
RA
D015652:25-Hydroxyvitamin D 2 / Q000097:blood; D000368:Aged; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D002136:Calcium, Dietary / Q000032:analysis; D016022:Case-Control Studies; D002149:Energy Intake; D006787:Hospitals, Veterans; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009749:Nutrition Surveys; D009751:Nutritional Requirements; D009752:Nutritional Status; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D012621:Seasons; D012709:Serum Albumin / Q000032:analysis; D013472:Sunlight; D014768:Virginia / Q000453:epidemiology; D014807:Vitamin D / Q000032:analysis / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology*
D002136:Calcium, Dietary; D010281:Parathyroid Hormone; D012709:Serum Albumin; D014807:Vitamin D; D015652:25-Hydroxyvitamin D 2; D010758:Phosphorus; D002117:Calcitriol; D002118:Calcium