Do you get vitamins from diet or pills? The case of vitamin D & calcium. Kent Managers Seminar 21 st April 2015 Tatiana Christides, MD

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1 Do you get vitamins from diet or pills? The case of vitamin D & calcium Kent Managers Seminar 21 st April 2015 Tatiana Christides, MD

2 About me Consultant in Internal Medicine in the US Involved in the medical care of older adults both in the community and at three separate care homes with nursing in the US In the UK Senior lecturer in nutrition and Biomedical Science at the University of Greenwich Faculty of Engineering and Science Research interests include nutrition in older adults, vitamin D, obesity, diabetes, and iron nutriture - please contact me if you have any questions

3 Today s Talk Background information on nutrition and the older adult including specific topics related to people in care homes and vitamin D & calcium Why should we care about vitamin D & calcium, why is it a problem, and how can we fix it diet versus pills? Our proposed future study

4 Nutrition & the older adult Intake of most nutrients falls with increasing age people over 85 years eat approximately 10% less than those aged years (NDNS) - risk for malnutrition increases with age Link between poor nutrition and common diseases; cardiovascular, poor immunity, osteoporosis, falls and fractures, and possibly mental illness and early dementia. Also increased hospitalisations & longer to discharge Incidence of malnutrition higher in institutionalised older people ranging from 2 to 38% of residents many reasons

5 Nutrition & the older adult vitamin D Certain nutrients especially problematic Vitamin D some 38% older adults living in care homes have low vitamin D blood levels Vitamin D essential for maintaining normal levels of calcium in the body, and bone and muscle strength and health Also important in immune function Risks associated with low vitamin D Falls Fractures Bone and muscle pain? Depression, cardiovascular disease, cancer, immune diseases such as rheumatoid arthritis

6 Nutrition & the older adult calcium Calcium some 4-10% older adults living in care homes have low dietary calcium intake Calcium essential for maintaining normal levels of calcium in the body and bone health Calcium essential for normal functioning muscles, nerves and the heart but the body defends blood levels of calcium very tightly so low blood levels only seen after years and years of inadequate intake

7 Vitamin D & older adults Main source of vitamin D? Main dietary sources vitamin D? Why might getting enough vitamin D be a problem for people living in care homes?

8 Vitamin D- main sources Sunlight Diet: Salmon Sardines Eggs Some fortified cereals Fortified fat spreads Some fortified milk powders

9 Vitamin D requirements people aged over 65 years old 10 micrograms a day Average UK intake 4 micrograms/day (NDNS) Average intake in people in care homes 2 micrograms/day (NDNS)

10 Vitamin D & older adults In addition as we age the same amount of sunlight on our skin produces less vitamin D The older gut absorbs less vitamin D The older gut is less sensitive to the actions of vitamin D and therefore absorbs less calcium Many medications decrease vitamin D and calcium levels

Vitamin D recommendations for the older adults Department of Health, Scientific Advisory Committee on Nutrition, and the National Institute for

11 Vitamin D recommendations for the older adults Department of Health, Scientific Advisory Committee on Nutrition, and the National Institute for Health and Care Excellence, all recommend that people over 65 and people living in care homes receive a daily vitamin D supplement of 10 micrograms a day

12 Calcium - main sources & recommended intake Milk products milk, cheese, yogurt, milkbased desserts Green leafy vegetables Fortified cereals including bread Sardines Soya products Nuts

13 Calcium pills. Recommended intake: 700 mg/day; DoH recommendations You should be able to get all the calcium you need by eating a varied and balanced diet

14 So, pill or diet? Vitamin D? Calcium? The answer may be different depending on the nutrient about which we are talking.

15 The question: are vitamin D supplements being given to people over the age of 65 living in care homes? We don t know Small number of studies suggest not We don t know why And where supplements are being used we also don t know why Talking to people suggests that combined calcium and vitamin D supplements most commonly prescribed if residents on any supplements at all

16 Our study Vitamin D supplementation in Kent Care Homes: an observational study of current practice Applying to the National Institute for Health Research funding stream Discover how many people in care homes receiving supplements and what kind Talk to residents, family, staff, GPs about barriers and facilitators to supplement use

Information on vitamins. Good for eyes, sight, skin and growth. Excess is harmful to pregnant women who should avoid vitamin A rich foods.

Information on vitamins. Good for eyes, sight, skin and growth. Excess is harmful to pregnant women who should avoid vitamin A rich foods. Information on vitamins. Vitamin A. Good for eyes, sight, skin and growth. Excess is harmful to pregnant women who should avoid vitamin A rich foods. Cod liver oil. Butter. Double cream. Cheese. Vitamin