Prevalence and incidence of iron deficiency in European community-dwelling older adults : An observational analysis of the DO-HEALTH trial

Background and aim Iron deficiency is associated with increased morbidity and mortality in older adults. However, data on its prevalence and incidence among older adults is limited. The aim of this study was to investigate the prevalence and incidence of iron deficiency in European community-dwelling older adults aged ≥ 70 years. Methods Secondary analysis of the DO-HEALTH trial, a 3-year clinical trial including 2157 community-dwelling adults aged ≥ 70 years from Austria, France, Germany, Portugal and Switzerland. Iron deficiency was defined as soluble transferrin receptor (sTfR) > 28.1 nmol/L. Prevalence and incidence rate (IR) of iron deficiency per 100 person-years were examined overall and stratified by sex, age group, and country. Sensitivity analysis for three commonly used definitions of iron deficiency (ferritin  1.5) were also performed. Results Out of 2157 participants, 2141 had sTfR measured at baseline (mean age 74.9 years; 61.5% women). The prevalence of iron deficiency at baseline was 26.8%, and did not differ by sex, but by age (35.6% in age group ≥ 80, 29.3% in age group 75–79, 23.2% in age group 70–74); P  1.5. Occurrences of iron deficiency were observed with IR per 100 person-years of 9.2 (95% CI 8.3–10.1) and did not significantly differ by sex or age group. The highest IR per 100 person-years was observed in Austria (20.8, 95% CI 16.1–26.9), the lowest in Germany (6.1, 95% CI 4.7–8.0). Regarding the other definitions of iron deficiency, the IR per 100 person-years was 4.5 (95% CI 4.0–4.9) for ferritin  1.5. Conclusions Iron deficiency is frequent among relatively healthy European older adults, with people aged ≥ 80 years and residence in Austria and Portugal associated with the highest risk

Associations of Calcium Intake and Calcium from Various Sources with Blood Lipids in a Population of Older Women and Men with High Calcium Intake

Promoting calcium intake is a cornerstone for osteoporosis management. Some individuals limit dairy product consumption, a major calcium source, due to their high content in saturated fats and their perceived negative impact on lipid profiles. This study explored the associations of calcium from various sources with blood lipids in community-dwelling elderly (n = 717) from the GERICO cohort. Dietary calcium intake was assessed at several timepoints using a validated food frequency questionnaire (FFQ) and calcium supplement use was recorded. Blood lipids were treated as categorical variables to distinguish those with normal and abnormal levels. Increasing total calcium intake was associated with lower risks for high total cholesterol (p = 0.038) and triglycerides (p = 0.007), and low HDL-cholesterol (p = 0.010). Dairy calcium (p = 0.031), especially calcium from milk (p = 0.044) and milk-based desserts (p = 0.039), i.e., low-fat (p = 0.022) and non-fermented (p = 0.005) dairy products, were associated with a lower risk of high total cholesterol. Greater calcium intakes from total dairies (p = 0.020), milk (p = 0.020) and non-fermented dairies (p = 0.027) were associated with a lower risk of hypertriglyceridemia. No association was observed between calcium from non-dairy sources, cheese or high-fat dairies and blood lipids. Increasing calcium through supplements was associated with lower risks for hypertriglyceridemia (p = 0.022) and low HDL-cholesterol (p = 0.001), but not after adjustments. Our results suggest that higher calcium intakes from dietary sources or supplements are not adversely associated with blood lipids in the elderly, whilst total, and particularly low-fat, dairy products are valuable calcium sources potentially related to favorable lipid profiles.</p

Associations between age-related changes in bone microstructure and strength and dietary acid load in a cohort of community-dwelling, healthy men and postmenopausal women

Background: The importance of dietary acid load (DAL) in the pathogenesis of osteoporosis is still debated. Age-related changes in bone microstructure and strength in relation to DAL remain largely unexplored. Objectives: We investigated the associations between changes in areal and volumetric bone mineral density (BMD), bone microstructure and strength, fracture risk, and DAL in a prospective cohort of 65-y-old healthy men and postmenopausal women

Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women

\u3cp\u3eA longitudinal analysis of bone microstructure in postmenopausal women of the Geneva Retirees Cohort indicates that age-related cortical bone loss is attenuated at non-bearing bone sites in fermented dairy products consumers, not in milk or ripened cheese consumers, independently of total energy, calcium, or protein intakes.\u3c/p\u3e\u3cp\u3eINTRODUCTION: Fermented dairy products (FDP), including yogurts, provide calcium, phosphorus, and proteins together with prebiotics and probiotics, all being potentially beneficial for bone. In this prospective cohort study, we investigated whether FDP, milk, or ripened cheese consumptions influence age-related changes of bone mineral density (BMD) and microstructure.\u3c/p\u3e\u3cp\u3eMETHODS: Dietary intakes were assessed at baseline and after 3.0 ± 0.5 years with a food frequency questionnaire in 482 postmenopausal women enrolled in the Geneva Retirees Cohort. Cortical (Ct) and trabecular (Tb) volumetric (v) BMD and microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computerized tomography, in addition to areal (a) BMD and body composition by dual-energy X-ray absorptiometry, at the same time points.\u3c/p\u3e\u3cp\u3eRESULTS: At baseline, FDP consumers had lower abdominal fat mass and larger bone size at the radius and tibia. Parathyroid hormone and β-carboxyterminal cross-linked telopeptide of type I collagen levels were inversely correlated with FDP consumption. In the longitudinal analysis, FDP consumption (mean of the two assessments) was associated with attenuated loss of radius total vBMD and of Ct vBMD, area, and thickness. There was no difference in aBMD and at the tibia. These associations were independent of total energy, calcium, or protein intakes. For other dairy products categories, only milk consumption was associated with lower decrease of aBMD and of failure load at the radius.\u3c/p\u3e\u3cp\u3eCONCLUSION: In this prospective cohort of healthy postmenopausal women, age-related Ct bone loss was attenuated at non-bearing bone sites in FDP consumers, not in milk or ripened cheese consumers, independently of total energy, calcium, or protein intakes.\u3c/p\u3e\u3cp\u3eSTUDY REGISTRATION: ISRCTN11865958 ( http://www.isrctn.com ).\u3c/p\u3

Prepubertal Impact of Protein Intake and Physical Activity on Weight-Bearing Peak Bone Mass and Strength in Males

This 15-year prospective study in boys documents the tracking from prepuberty to the attainment of peak bone mass and strength of the positive interaction between protein intake and physical activity

Peripheral skeleton bone strength is positively correlated with total and dairy protein intakes in healthy postmenopausal women

Bone mineral content (BMC) and bone mineral density (BMD) are positively correlated with dietary protein intakes, which account for 1-8% of BMC and BMD variances. However, the relation between bone strength and microstructure, which are variables that are not captured by areal bone mineral density (aBMD), and dietary protein intakes, particularly from specific dietary sources, has not been clearly established

Fracture prospectively recorded from prepuberty to young adulthood:are they markers of peak bone mass and strength in males?

\u3cp\u3eFractures are common in otherwise healthy children and adolescents. They result from trauma of varying severity. Some reflect a greater skeletal fragility. A long-term implication of these fractures is their potentiality to predict adult bone fragility and increased risk of osteoporosis in later life. Using dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and micro-finite element analysis (μFEA) measurements, we previously found in 124 healthy females, followed from the age of 7.9 to 20.4 years, substantial deficits in both structural and strength components of the radius in the 42 girls who sustained a fracture during skeletal development. The objective of the current study was to assess in healthy males the relationship between fracture during development and expression of bone fragility in adulthood. A cohort of 152 boys was followed from age 7.4 ± 04 (mean ± SD) to 22.6 ± 0.7 years, ie, when peak bone mass is attained. Ninety participants (59.2%) sustained at least one fracture during growth, with highest incidence within the 10- to 13-year age range. Forearm was the most frequent site of fractures. At 7.4 years, several bone DXA-measured variables (areal bone mineral density [aBMD], bone mineral content [BMC]) were lower in the group with a positive fracture history during skeletal development compared with the non-fractured group. In contrast, at 22.6 years, no DXA-measured sites, including forearm, indicated a deficit in the fractured group compared with the non-fractured group. Likewise, at 22.6 years, neither HR-pQCT nor μFEA measurements, including distal radius, showed a structural or strength deficit in the fractured group. These results markedly contrast with a similar prospective study using the same technical and clinical design in 124 healthy girls. In conclusion, our prospective studies suggest a sex difference in the predictability of bone fragility in young adults who sustained fractures during childhood and adolescence. This difference might be related to the degree of trauma severity, usually lower in girls than in boys.\u3c/p\u3

Prepubertal impact of protein intake and physical activity on weight bearing peak bone mass and strength in males

\u3cp\u3eCONTEXT: Peak bone mass (PBM) and strength are important determinants of fragility fracture risk in later life. During growth bone is responsive to changes in nutrition and physical activity (PA), particularly when occuring before pubertal maturation.\u3c/p\u3e\u3cp\u3eOBJECTIVE: In prepubertal healthy boys, protein intake (Prot-Int) enhances the impact of PA on weight-bearing bone. We hypothesized that the synergism between Prot-Int and PA on proximal femur as recorded at mean age of 7.4 years would track until PBM.\u3c/p\u3e\u3cp\u3eMETHODS: 124 boys were followed from 7.4 to 15.2 and 22.6 years. At 7.4 years they were dichotomized according to the median of both PA and Prot-Int.\u3c/p\u3e\u3cp\u3eRESULTS: In boys with PA &gt; Median (310 vs 169 kcal.d(-1)), higher vs low Prot-Int (57.7 vs 38.0 g.d(-1)) was associated with +9.8% greater femoral neck (FN) BMC (P=0.027) at 7.4 years. At 15.2 and 22.6 years, this difference was maintained: FN BMC: +12.7% (P=0.012) and +11.3% (P=0.016), respectively. With PA &gt; Median, in Prot-Int &gt; vs &lt; Median, differences in FN BMC Z-scores were +0.60, +0.70 and +0.68 at 7.4, 15.2 and 22.6 years, respectively, and also associated with greater FN width. Micro-finite element analysis of the distal tibia at 15.2 and 22.6 years indicated that in the two groups with PA &gt; Median, CSA, stiffness and failure load were greater in Prot-Int &gt; vs &lt; Median.\u3c/p\u3e\u3cp\u3eCONCLUSIONS: This study demonstrates the crucial influence of Prot-Int on the response to enhanced PA and the importance of prepubertal years for modifiying, by environmental factors, the bone growth trajectory and, thereby, for achieving higher PBM and greater strength in healthy male subjects.\u3c/p\u3