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Relationship Between Serum Parathyroid Hormone Levels, Vitamin D Sufficiency, and Calcium Intake
Laufey Steingrimsdottir, PhD;
Orvar Gunnarsson, MD;
Olafur S. Indridason, MD, MHS;
Leifur Franzson, MSc, Pharm;
Gunnar Sigurdsson, MD, PhD
JAMA. 2005;294:2336-2341.
Context Adequate vitamin D status for optimum bone health has received increased recognition in recent years; however, the ideal intake is not known. Serum 25-hydroxyvitamin D is the generally accepted indicator of vitamin D status, but no universal reference level has been reached.
Objective To investigate the relative importance of high calcium intake and serum 25-hydroxyvitamin D for calcium homeostasis, as determined by serum intact parathyroid hormone (PTH).
Design, Setting, and Participants Cross-sectional study of 2310 healthy Icelandic adults who were divided equally into 3 age groups (30-45 years, 50-65 years, or 70-85 years) and recruited from February 2001 to January 2003. They were administered a semi-quantitative food frequency questionnaire, which assessed vitamin D and calcium intake. Participants were further divided into groups according to calcium intake (<800 mg/d, 800-1200 mg/d, and >1200 mg/d) and serum 25-hydroxyvitamin D level (<10 ng/mL, 10-18 ng/mL, and >18 ng/mL).
Main Outcome Measure Serum intact PTH as determined by calcium intake and vitamin D.
Results A total of 944 healthy participants completed all parts of the study. After adjusting for relevant factors, serum PTH was lowest in the group with a serum 25-hydroxyvitamin D level of more than 18 ng/mL but highest in the group with a serum 25-hydroxyvitamin D level of less than 10 ng/mL. At the low serum 25-hydroxyvitamin D level (<10 ng/mL), calcium intake of less than 800 mg/d vs more than 1200 mg/d was significantly associated with higher serum PTH (P = .04); and at a calcium intake of more than 1200 mg/d, there was a significant difference between the lowest and highest vitamin D groups (P = .04).
Conclusions As long as vitamin D status is ensured, calcium intake levels of more than 800 mg/d may be unnecessary for maintaining calcium metabolism. Vitamin D supplements are necessary for adequate vitamin D status in northern climates.
Author Affiliations: Public Health Institute of Iceland (Dr Steingrimsdottir); University of Iceland (Drs Gunnarsson and Sigurdsson); and Department of Medicine (Drs Indridason and Sigurdsson) and Clinical Chemistry (Dr Franzson), Landspitali-University Hospital, Reykjavik, Iceland.
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