Vitamin D status in mothers with pre-eclampsia and their infants: a case-control study from Serbia, a country without a vitamin D fortification policy

Objective: The objective of the present study was to determine if vitamin D intake and status are associated with pre-eclampsia in a country without a vitamin D fortification policy. Design: A case-control study of pregnancies with (case) and without (control) pre-eclampsia was conducted from January to April when UVB is minimal. Maternal and cord blood obtained at delivery were measured for plasma 25-hydroxycholecalciferol (25-OH-D-3), 3-epimer of 25-OH-D-3 (3-epi-25-OH-D-3) and 24,25-dihydroxycholecalciferol (24,25-(OH)(2)D-3) by LC-MS/MS and maternal 1,25-dihydroxyvitamin D (1,25-(OH) 2D). Differences between groups were tested with ANOVA and Bonferroni post hoc tests (P lt 0.05). Setting: Clinical Center of Serbia. Subjects: Pregnant women with and without pre-eclampsia (n 60) and their infants. Results: Exogenous vitamin D intake (0.95-16.25 mu g/d (38-650 IU/d)) was not significantly different between groups. Women with pre-eclampsia delivered infants at an earlier gestational age and had significantly lower mean total plasma 25-hydroxyvitamin D (25-OH-D; case: 11.2 (SD 5.1); control: 16.1 (SD 5.7) ng/ml; P=0.0006), 25-OH-D-3 (case: 10.0 (SD 4.9); control: 14.2 (SD 5.8) ng/ml; P=0.002), 3-epi-25-OH-D-3 (case: 0.5 (SD 0.2); control: 0.7 (SD 0.2) ng/ml; P=0.0007) and 1,25-(OH)(2)D (case: 56.5 (SD 26.6); control: 81.0 (SD 25.7) pg/ml; P=0.018), while 24,25-(OH)(2)D-3 was not different between groups. Infants did not differ in total plasma 25-OH-D, 25-OH-D-3, 3-epi-25-OH-D-3 and 24,25-(OH)(2)D-3, but the mean proportion of 3-epi-25-OH-D-3 was higher in the infant case group (case: 7.9 (SD 1.1); control: 7.0 (SD 1.4) % of total 25-OH-D-3; P=0.005). Conclusions: A high prevalence of vitamin D deficiency, as defined by plasma 25-OH-D lt 12 ng/ml, was observed in 47 % of all mothers and 77 % of all infants. These data underscore the need for prenatal vitamin D supplementation and a food fortification policy in Serbia

Validity of an FFQ assessing the vitamin D intake of young Serbian women living in a region without food fortification: the method of triads model

Objective: The objective of the present study was to examine the external validity of an FFQ designed to estimate dietary vitamin D intake compared with a plasma biomarker and three repeated 24 h dietary recalls in women of reproductive age in Serbia, where there is no exposure to food fortified with vitamin D. The method of triads was applied. Design: In a cross-sectional study, 422 women completed the Women and Reproductive Health FFQ (WRH-FFQ) during the winter months. From a representative subgroup (n 44), three 24 h dietary recalls and anthropometric parameters were collected as well as a fasting blood sample for vitamin D biomarker analyses. Correlation coefficients were calculated between each of the dietary methods. Validity coefficients, as a correlation between the measured and estimated 'true' exposure, were calculated using the method of triads. Bland-Altman plots were also constructed. Setting: Three major universities in Serbia. Subjects: Healthy young women (n 422) aged 18-35 years. Results: The WRH-FFQ estimate of vitamin D intake for all participants was 4.0 (SD 3.3) mu g/d and 3.1 (SD 2.3) mu g/d for the subgroup. Bland-Altman plots for these intakes showed high agreement. Validity coefficients for the FFQ, 24 h recall and biomarker were. rho(QI) = 0.847 (95 % CI 0.564, 0.928), rho(RI) = 0.810 (95 % CI 0.537, 0.997) and rho(BI) = 0.499 (95 % CI 0.190, 0.840), while the correlation coefficients were 0.686, 0.422 and 0.404. Conclusions: The FFQ applied in the present study is a valid tool for assessing dietary vitamin D intake in women living in Serbia, a region without mandatory vitamin D food fortification

Assessment of vitamin D intake among Libyan women - adaptation and validation of specific food frequency questionnaire

Vitamin D deficiency (VDD) has pandemic proportions worldwide. Numerous studies report on high prevalence of VDD in sunny regions like Near East and North Africa (NENA). Previous studies indicated that Libyan population was at risk of VDD. To contribute to the body of evidence, measurement of vitamin D status on children, adults, in Misurata region was conducted, and confirmed with validated dietary intake study. Serum 25(OH)D was analysed using electrochemiluminescence protein binding assay. Existing Food Frequency Questionnaires (FFQ) were adapted to Libyan Women Food Frequency Questionnaire (LW-FFQ). Repeated 24h dietary recalls and LW-FFQ were employed in vitamin D intake evaluation. LW-FFQ was validated using 24h dietary recall and vitamin D status as referent methods. The questionnaires included anthropometry and lifestyle information. Vitamin D status assessment revealed inadequate levels (25(OH)D lt 50nmol/l) in almost 80% of participants. Women (25-64y) were identified as the most vulnerable group with vitamin D inadequacy present in 82% (61.6% had 25(OH)D lt 25nmol/l, and 20.2% had 25-50nmol/l 25(OH)D). Average Vitamin D intake within the study sample (n=316) was 3.9 +/- 7.9 mu g/d, with 92% participants below both Institute of Medicine (IOM) (10 mu g/d) and European Food Safety Authority (15 mu g/d) recommendations. Measured vitamin D status, in 13% of this group, correlated significantly (p=0.015) with intake estimates. Based on self-report, consumption of vitamin D supplements does not exist among study participants. Additional lifestyle factors influencing vitamin D status were analysed. Only 2% of study participants spend approximately 11 min on the sun daily, 60.4% were obese, 23.1% were overweight and 71.2% reported low physical activity. These findings confirm previous reports on high prevalence of VDD in women across NENA, and in Libya. The situation calls for multi-sectoral actions and public health initiatives to address dietary and lifestyle habits