Abstract

Berbagai penelitian menunjukkan bahwa defisiensi vitamin D dan hiperpara-tiroidisme sekunder menimbulkan dampak serius pada kesehatan, antara lain meliputi osteoporosis, osteomalasia, kelemahan otot, jatuh dan fraktur osteoporotik. Tujuan penelitian ini adalah (1) mengetahui pengaruh pajanan UVB sinar matahari pada konsentrasi 25(OH)D dan hormon paratiroid (PTH) perempuan usia lanjut Indonesia. (2) mendapatkan saat dan lama pemajanan yang optimal. Penelitian uji klinik acak terbuka ini melibatkan 74 perempuan berusia 60 - 90 tahun yang tinggal di 4 panti werda di Jakarta dan Bekasi. Randomisasi dilakukan untuk memisahkan kelompok studi dan kontrol. Kelompok kontrol hanya mendapat kalsium 1000 mg/hari, sedang kelompok intervensi dipajankan dengan matahari selama 6 minggu. Hasil yang diukur sebelum dan sesudah 6 minggu pemajanan adalah konsentrasi 25(OH)D, PTH, dan ion kalsium. Ditemukan bahwa, waktu pemajanan yang optimal adalah 1 jam sebelum dan sesudah tengah hari. Prevalensi defisiensi vitamin D pada wanita usia lanjut adalah 35,1%. Pada kelompok terpajan, konsentrasi 25(OH)D meningkat lebih tinggi daripada yang tidak dipajan (51,8% vs 12,5%). Hasil tambahan adalah rerata asupan kalsium 248 mg/hari, dan rerata asupan vitamin D 28 IU/hari.

Many studies showed that vitamin D deficiency and secondary hyper-parathyroidism cause serious impact on health including osteoporosis, osteomalacia, paralysis, fall, and osteoporotic fracture. This study was conducted to compare the effect of UVB from sunlight exposure in combination with calcium supplementation, and control (calcium only) on the vitamin D status and parathyroid hormone (PTH) concentration in Indonesian elderly women. This study was a randomized clinical trial in institutionalized care unit. Subjects included 74 elderly women with a mean age 71 years. Intervention was random allocation of UVB from sunlight exposure at 0.6 MED/hour noted in the UV meter on the face and both arms and calcium 1000 mg, three times per week for 6 weeks, and without treatment (calcium 1000 mg only). Main outcome measured were fasting serum levels of 25(OH) D, PTH, and calcium ion at 0 and 6 weeks in both treatment and control groups. The incidence of vitamin D deficiency in this population study was 35.1 %. In the treatment group, 25(OH) D increased from 59.1 nmol/L to 84.3 nmol/L (mean value after 6 weeks of sunlight exposure) with only a slight increase of 25(OH) D in the control group (51.8% vs 12.5%). 25(OH)D deficient levels in 15 out 16 subjects became normal after 6 weeks of sun exposure. There was no change of PTH levels in both groups. Additional results of this study are mean calcium intake of 248 mg/day and vitamin D intake of 28 IU/day.

References

  1. Riggs, B.L. and L.J. Melton, 3rd, The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone, 1995. 17(5 Suppl): p. 505S-511S.
  2. NIH concensus development panel on optimal calcium intake. JAMA, 2004. 272: p. 1942.
  3. Law, M.R. and A.K. Hackshaw, A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. Bmj, 1997. 315(7112): p. 841-6.
  4. Cummings, S.R., et al., Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med, 1995. 332(12): p. 767-73.
  5. Cumming, R.G., et al., Calcium intake and fracture risk: results from the study of osteoporotic fractures. Am J Epidemiol, 1997. 145(10): p. 926- 34.
  6. Christodoulou, C. and C. Cooper, What is osteoporosis? Postgrad Med J, 2003. 7: p. 133-138.
  7. Ringe, J.D. and E. Schacht, Prevention and therapy of osteoporosis: the roles of plain vitamin D and alfacalcidol. Rheumatol Int, 2004. 24(4): p. 189-97.
  8. Sahota, O., Osteoporosis and the role of vitamin D and calcium-vitamin D deficiency, vitamin D insufficiency and vitamin D sufficiency. Age Ageing, 2000. 29(4): p. 301-4.
  9. Miller, S., Calcium and vitamin D deficiencies: a world issues? FNA/ANA, 1997: p. 27-31.
  10. Nordin, B.E., Calcium and osteoporosis. Nutrition, 1997. 13(7-8): p. 664-86.
  11. Papadimitropoulos, E., et al., Meta-analyses of therapies for postmenopausal osteoporosis. VIII: Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev, 2002. 23(4): p. 560-9.
  12. Chapuy, M.C., et al., Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med, 1992. 327(23): p. 1637-42.
  13. Baylink, D., Calcium and bone hemostasis and changes with aging, in Principles of geriatric medicine and gerontology, H. WR, Editor. 2003, McGraw-Hill: USA. p. 973-86.
  14. Garfia, B., S. Canadillas, and A. Canalejo, Regulation of parathyroid vitamin D receptor expression by extracelluler calcium. J Am Soc Nephrol, 2003. 13: p. 2945-52.
  15. Ooms, M.E., et al., Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind trial. J Clin Endocrinol Metab, 1995. 80(4): p. 1052-8.
  16. Rajakumar, K., Vitamin D, cod liver oil, sunlight, and rickets: a historical perspective. Pediatrics, 2003. 112: p. 132-4.
  17. Visser, M., D. DJH, and P. Lips, Low vitamin D and high parathyroid hormone levels as determinants of lost muscle strength and muscle mass (sarcopenia): The longitudial aging study Amsterdam. J Clin Endocrinol Metab, 2003. 88: p. 5766-772.
  18. Peterlik, M. and H. Coss, Vitamin D and calsium deficits predispose for multiple chronic diseases. Eur J of Clin Invest, 2005. 35: p. 290-304.
  19. Lips, P., et al., A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of raloxifene evaluation clinical trial. J Clin Endocrinol Metab, 2001. 86(3): p. 1212-21.
  20. MacLaughlin, J. and M.F. Holick, Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest, 1985. 76(4): p. 1536-8.
  21. Nakamura, K., Fish as a major source of vitamin D in the Japanese diet. Nutrition, 2002. 18: p. 415-6.
  22. Adams, J.S., et al., Vitamin-D synthesis and metabolism after ultraviolet irradiation of normal and vitamin-D-deficient subjects. N Engl J Med, 1982. 306(12): p. 722-5
  23. Barger-Lux, M.J. and R.P. Heaney, Effects of above average summer sun exposure on serum 25-hydroxyvitamin D and calcium absorption. J Clin Endocrinol Metab, 2002. 87(11): p. 4952-6.
  24. Holick, MF. Capacity of human skin to produce vitamin D3. In: Kligman AM, Takase Yoshio. (eds). Cutaneous Aging. Japan, University of Tokyo Press, 1988.198 : 223- 45.
  25. Jablonski, N.G. and G. Chaplin, The evolution of human skin coloration. J Hum Evol, 2000. 39(1): p. 57-106.
  26. Diffey, B., Climate change, ozone depletion and the impact on ultraviolet exposure of human skin. Phys Med Biol, 2004. 49(1): p. R1-11.
  27. Oemardi, M., Efek menopause terhadap densitas mineral tulang dan variabel biokimia metabolisme tulang perempuan Indonesia berusia 45-55 tahun. (In press), 2002.
  28. Holick, M.F., L.Y. Matsuoka, and J. Wortsman, Age, vitamin D, and solar ultraviolet. Lancet, 1989. 2(8671): p. 1104-5.
  29. Clemens, T.L., et al., Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet, 1982. 1(8263): p. 74-6.
  30. Silver, J., Pathogenesis of parathyroid dysfunction in end-stage renal disease. Adv Ren Replace Ther, 2002. 9(3): p. 159-67

Download

Included in

Nutrition Commons

Share

COinS