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Dietary sources of vitamin D and seasonal variations of 25 (OH) vitamin D serum levels in men over 45 years of age in Latvia
2. Zhukov B. L. [Unilateral Associated fractures of femur and tibia and tactics of their treatment]. Odnos-toronnie sochetannye perelomy bedra i goleni i taktika ih lechenija. V kn.: Materialy tret’ego s’ezda travmatologov-ortopedov respublik Srednei Azii i Kazahstana. [Proceedings of the Third Congress of the Orthopaedic Trauma republics of Central Asia and Kazakhstan]. Tashkent; 1982. S. 93-95. [in Rus.]
3. Ibrohimov G. I. s soavt. [Surgical treatment ofmultiple diaphyseal fractures oflong bones]. Operativnoe lech-enie mnozhestvennyh diafizarnyh perelomov trubchatyh kostei. V kn.: Sovremennye tehnologii v travma-tologii i ortopedii. [Modern technologies in traumatology and orthopedics]. М.; 1999; S. 98-99. [in Rus.]
4. Kapustin R. F., Volod‘ko F. F., Lazut‘ko I. N., Shtut‘ko O. L. [Extramedullary stable-functional osteosynthesis in patients with combined injuries]. Nakostnyi stabilno-funkcionalnyi osteosintez u postradavshih s sochetannymi povrezhdenijami. [Actual problems of traumatology and orthopedics. Materials of Republican scientific-practical conference]. V kn.: Aktual’nye problemy travmatologii i ortopedii. Materialy Respublikanskoi nauchno-prakticheskoi konferencii. М.; 1995. S. 36-38. [in Rus.]
5. Klyuchevskii V. V. [Dempferired skeletal extension], Dempferirovannoe skeletnoe vytjazhenie, Yaroslavl: Ver-Volj. Publ., 1982. - 207 s.
6. Ohotskiy V. P., Balabanenko G. M. [Treatment unilateral fractures of the lower limbs]. Lechenie odnos-toronnih dvuhsegmentarnyh perelomov nizhnih konechnostei. Vestnik hirurgii im. I. I. Grekova. [Journal of surgery. I. I. Grekova]. 1979; (4):87-90. [in Rus.].
7. Gustilo R. B., Anderson J. T. J. Bone Jt Surg.1976; 58:453-458.
8. Heuwinkel R. et al. Osteosynthese. - Zeitpunkt und ubermassige Knochenheubildung beim Schadel-hirntrauma. Akt. Traumatol. 1978; 8 (6):447-452.
9. Johner R., Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop 1983; 178:7-25.
10. Krettek C., Simon R. G., Tscherne H. Management priorities in patients with polytrauma. Langenbecks Arch Surg. 1998; 383 (3):220-227.
11. Sterk J., Willy C., Gerngross H. Femur osteosynthesis in the polytrauma patient - considerations for reasonable surgery time frame from the viewpoint of military service medical treatment. Langenbecks Arch Chir Suppi Kongressbd 1997; 114:1005-1010.
Sitova Anastasia,
Rigas Stradins University, Doctoral Studies of „Medicine", Sanatorium „Jantarnij Bereg” nutritionist, Latvia,
E-mail: ashitova@inbox.lv Voika Olga, Riga Stradins University, Language Center, MD, Maeg. Paed, Latvia Erts Renars, Riga Stradins University, Department of Physics Doc. Latvia Zarins Zigurds, Riga Stradins University, Faculty of Rehabilitation Sports, Nutrition and Education Department Associate Professor, Latvia
Dietary sources of vitamin D and seasonal variations of 25 (OH) vitamin D serum levels in men over 45 years of age in Latvia
Abstract: Introduction. Over 50% of population are found to suffer from vitamin D deficiency. Vitamin D deficiency in Europe, Northern Europe, especially in elderly people, was revealed by
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Section 1. Clinical medicine
many epidemiological studies. Insufficient vitamin D intake was detected in the population of the North America and Eastern Europe, comprising only 50% of vitamin D daily recommended dose.
Materials and methods. 134 males aged 45-80 were included in the research. None of the research participants were taking any vitamin D supplements or other supplements containing vitamin D. Serum vitamin D level ((25 hydroxylvitamin D: 25 (OH)D) was measured in all the participants and the amount of vitamin D taken with the diet was determined. The participants’ height and weight were measured to calculate BMI and a survey on the amount of vitamin D consumed with food was conducted.
Results. Insufficient vitamin D intake was detected in 78,4%, vitamin D deficiency with consequent low vitamin D serum level — 94,1%. The mean data: vitamin D in food — 6,9 pg, 25 (OH) D — 16,9 ng/mL, BMI — 28,1 kg/m2, age — 59,4 years. The amount of vitamin D in food statistically reliably directly correlates with serum vitamin D level (r=0,961; p=0,01), there is also an inverse correlation with age (r=0,226; p=0,009). Vitamin D serum level correlates inversely with age (r=0,184; p=0,033). No statistical reliable correlation was found between serum 25 (OH) D levels and BMI. The major dietary sources of vitamin D are fat-rich sea fish, eggs, and dairy products.
Conclusion. Both insufficient intake of vitamin D with food and low serum level were marked in males of advancing age — 94.1%. Serum vitamin D level directly correlates with vitamin D intake. No statistically significant correlation among vitamin D levels, vitamin D in diet or BMI were found, although there was inverse correlation with age.
Keywords: 25-hydroxy-D3 vitamin, 7-dehydrocholesterol, dietary sources, body mass index (BMI).
Introduction
Vitamin D deficiency rickets in children and osteomalacia due to Calcium malabsorption in adults were long thought to be the only manifestations of vitamin D deficiency [1, 1629-1637; 2]. However, nowadays vitamin D deficiency has been linked to the development of such chronic diseases as osteoporosis, multiple sclerosis [3, 2832-2838], cardiovascular diseases and cancer [4, 39-48]. Many types of human body tissue have vitamin D receptors, the ability to synthesize a-hydroxylase, and, moreover, vitamin D itself. Nevertheless, the amount of vitamin D needed to provide the optimal health is still discussed by many researchers and clinicians. They consider both higher amounts and limits of normal 25 (OH)D serum level from 50 and over 75 nmol/mL necessary to prevent vitamin D deficiency and insufficiency [5, 542-550; 6, 53-58]. Healthy adult individuals get the most of their vitamin D from exposure to sunlight [1, 1629-1637]. With a diet vitamin D is obtained in limited amount [7, 1678-1688]. Therefore, seasonality [8, 860-868], latitude [9, 693-701], and life
style are the factors expected to affect vitamin D. In the Northern European countries vitamin D synthesis from the sun light is insufficient due to several factors. The population tend to stay indoors in the light period of the day. In the northern latitudes (57 °) cyclones taken away sea air masses from the Atlantic Ocean, in the warm seasons it results in foggy and rainy weather [10, 1287-1290]. For instance, in Scotland (the higher latitudes) the highest 25 (OH) D serum level is below 16 ng/mL compared with other UK population [8, 260-268; 11, 2461-2472].
Latvia is located in the northern latitudes 55°-58°, therefore, the sunlight waves of 260-320 nm nedeed for vitamin D synthesis in the skin can not reach the Earth between the end of November and the beginning of February [12, 14-18]. In the recent years vitamin D deficiency in adults has been recognized as a nutritional problem in the USA. The results from the National Health and Nutrition Examination Survey of 2000-2004 showed that over 10% males and 15% females suffer from moderate vitamin D insufficiency, that was defined as serum 25 (OH)D3 < 15 ng/mL. [13, 1519-1527].
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Dietary sources of vitamin D and seasonal variations of 25 (OH) vitamin D serum levels in men over 45 years of age in Latvia
The aim of the study. To determine dietary sources of vitamin D, prevalence of vitamin D deficiency and insufficiency in male population over 45 years of age in Latvia. To determine whether there is any correlation between vitamin D intake, its serum level, BMI and age.
Materials and methods
The research was conducted between 26.10.2012 and 18.04.2014. The majority of the research participants included lived in the urban areas. Influence of UVB radiation was taken into consideration depending on the season.
Inclusion criteria:
— Male gender
— Between 45 and 80 years of age
— Absence of oncology in familial history
— Live at home, consume simple food
Exclusion criteria:
— Vitamin D supplement intake, as well as dietary supplements containing vitamin D
— Oncology diseases
— Chronic kidney disease
— Chronic liver disease
— Diarrhoea
Biomedical research. Quantitative research method was implemented. „Food Consumption Frequency Questionnaire” was used as a research instrument. This method has been used in many research works, to detect vitamin D insufficiency. Vitamin D in dietary sources (pg/100g) was measured by means of the questionnaire. The German Nutrient Database BLS (Bundeslebensmittelschlüssel) of the Max Rubner-Institut was implemented in the research.” Food safety,
animal health and environmental research institute” (BIOR) program was used for the data processing of the dietary frequency questionnaire.
Vitamin D (25 hydroxylvitamin D 25 (OH)D) serum level was measured by the immunchemilumi-niscence method (Liaison). Mild vitamin D insufficiency was designated if 25 (OH)D serum level was < 30 ng/mL, moderate vitamin D insufficiency between 20 and 29 ng/mL, pronounced vitamin D insufficiency from 10 to 20 ng/mL, and vitamin D deficiency, if 25 (OH)D serum level was < 10 ng/mL. Vitamin D toxicity starts at 25 (OH) D serum level > 150 ng/mL. The data were processed by „Food safety, animal health and environmental research institute” (BIOR) program, Excel 2010, IBM SPSS 21.0.
Results
158 males were included in the research, of whom 24 were excluded due to oncology diagnosis -prostate cancer. Vitamin D level was measured in 134 males.
The mean age of the males included in the research was 59,4 ± 8,4 years. 31,3% were younger than 55 years. The mean BMI was 28,1 ± 3,9 kg/m2 (20-41 kg/m2). Obesity (BMI > 30) was detected in 27,6% of males, increased weight was observed in 50,7% of cases.
The mean daily vitamin D amount consumed with the diet was 6,9 ± 5,2 pg (276 ± 208 IU), the minimal amount of vitamin D — 0,2 pg (8 IU), the maximal — 30 pg (1200 IU). The demographic characteristics of the research participants are reflected in the Table 1.
Table 1. - Demographic characteristics of the respondents (levels of vitamin D serum and dietary vitamin D, BMI)
Characteristics of the research participants n (%)
1 2
Number 134 (100)
Age, years
45 -55 42 (31,3)
55-65 57 (42,5)
>65 35 (26,1)
BMI (kg/m2)
19-24,9 29 (21,6)
25-29,9 68 (50,7)
>30 37 (27,6)
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Section 1. Clinical medicine
1 2
25 (OH)D measured seasonally
Autumn 85 (63,4)
Spring 49 (36,6)
25 (OH)D serum level (ng/mL)
<10 (deficiency) 32 (23,9)
10-20 (pronounced insufficiency) 69 (51,5)
21 -29 (moderate insufficiency) 25 (18,7)
> 30 (normal limit) 8 (6,0)
Vitamin D in diet gg (IU)
<5 (200IU) 64 (47,8)
5 -10 (200 -400 IU) 41 (30,6)
10-15(400-600IU) 19 (14,2)
>15 (> 600 IU) 10 (7,5)
The mean vitamin D 25 (OH)D serum level was 16,9 ± 7,6 ng/mL (2,2-43,2 ng/mL). Vitamin D deficiency was observed in 23,9% (n=32), pronounced insufficiency in 51,5% (n=69),
moderate insufficiency — 18,7% (n=25) and only in 6% of males (n=8) vitamin D level was within normal limits.
Vitamin D serum level was measured from September to April. Depending on the season
two groups were made: the autumn (September, October, November) and spring (March, April, May). In 63,4% (n=85) vitamin D serum level was measured in the autumn and 36,6% (n=49) in spring. The mean vitamin D serum level measured in autumn was 17,5 ± 7,6 ng/mL (4,8-43,2 ng/mL), and in spring -15,8 ± 7,7 ng/mL (2,2-39,3 ng/mL). Distribution of vitamin D serum level in the spring and autumn is reflected in the Fig 1.
Fig. 1. Vitamin D level distribution histogram in the spring and autumn
The average amount of vitamin D consumed with herring -3,5 gg (140 IU) daily (0-20,7 gg/d), salmon — 2,6 gg (104 IU) daily (0-30 gg/d), eggs -0,5 gg (20 IU) daily (0-5 gg/d), daily products:
butter 0,2 gg (8 IU) daily, sweet cream 0,12 gg (5 IU) daily, mackerel — 0,14 gg (6 IU) daily (0-4,5 gg/d), that shown in the Table 2.
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Dietary sources of vitamin D and seasonal variations of 25 (OH) vitamin D serum levels in men over 45 years of age in Latvia
Table 2. - The average amount of vitamin D in various products (pg/100g product)
Vitamin D amount (pg) in 100g of product N Minimal Maximal Average (SD) IU (%)
Salmon, raw 133 0 30,3 2,6 (1,4) 104 36,5
Herring, pickled 126 0 20,7 3,5 (2,8) 140 49,2
Mackerel, smoked 122 0 4,5 0,14 (0,09) 5,6 2,8
Egg, boiled 120 0 5,0 0,5 (0,3) 20 7
Butter 93 0 1,0 0,2 (0,08) 8 2,8
Sweet cream 18 0 0,8 0,12 (0,18) 4,8 17
SD — standard deviation, IU- international unit.
The average level of energy intake in the participants of the research was — 3380,2 kcal ± 1084,9 (1287,9-7175,0 kcal): in males over 4555 of age — 3341 ± 119 kcal/daily (95% CI), 5565 years of age — 3041 ± 112 kcal/daily (95% CI), and over 65 years — 2546 ±154 kcal/daily (95% CI). The daily intake of carbohydrates was -345,0 ± 131,6. The amount of carbohydrates consumed
(102,2-760,5 g/d), proteins — 154,8 ± 62,3 g daily (61,2-415,8 g/d), fats — 148,3 ± 56,7 g daily (53,5333,7 g/d), „ballast” substances — 28,6 ± 12 g daily (2,6-56,9 g/d). The average intake of polyunsaturated fatty acids was — 20,4 ± 10,8 g/daily, monounsaturated fatty acids -3,3 ± 5,1 g/day, saturated fatty acids — 22,3 ± 13,6 g/d. All the data have been reflected in the Table 3.
Table 3. - Mean nutritional value (g.) and total energy (kcal)
Min. Max. Mean (SD) E%
Energy (kcal) 1287,9 7175,0 3380,2 (1084,9)
carbohydrates (g) 102,2 760,5 345,0 (131,6) 53
proteins (g) 61,2 415,8 154,8 (62,3) 24
fats (g) 53,5 333,7 148,3 (56,7) 23
„ballast” substances (g) 2,6 56,9 28,6 (12,0)
polyunsaturated acids 3,7 57,4 20,4 (10,8)
monounsaturated acids 4,7 30,1 13,3 (5,1)
saturated acids 2,5 73,7 22,3 (13,6)
The working hypothesis about a correlation between vitamin D intake and 25 (OH)D serum level in males have been statistically verified. One-sample t-tests showed that the numbers obtained include in the confidence interval (p > 0,005), as well as there also have been checked the data concerning the age of the respondents, BMI, and the mean value of the consumed vitamin D, standard deviation depending on the vitamin D.
Vitamin D serum level has been measured in subjects depending on their BMI. In the males with normal BMI (19-24,9 kg/m2) the mean vitamin D serum level was 17,3 ng/mL; with elevated BMI (25-29,9 kg/m2) it was 16,8 ng/mL, and in obese males (> 30 kg/m2) — 16,3 ng/mL.
Statistically significant correlation has been found between 25 (OH)D serum level and vitamin D level in food sources (r = 0,961; p = 0,01).
Indirect correlation has been found between 25 (OH)D serum level and age (r = 0,184; p = 0,033), as well as between vitamin D content in the diet and age (r = 0,047; p = 0,009), that is shown in the Fig. 2.
Discussion
The age of the research participants between 45 and 80 years has been chosen since the risk of oncology, cardiovascular diseases, osteoporosis, osteomalacia, etc. increases in this age interval. The average life expectancy of Latvian males is 10 years shorter than that of females. The average life expectancy comprises 72,7 years: it is 67,3 years in males and 77,7 years in females. According to the Standardized mortality rate data, 48% of males in Latvia die before 65 years of age, while in the European Union (EU) only 29% of males die at this age [14, 9-10].
Data analysis confirmed the expected results on vitamin D deficiency in men with advancing age.
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Vitamin D deficiency and insufficiency is common -94,1%. The research results from different countries vary, but, anyway, in almost all countries worldwide both vitamin D deficiency and insufficiency have been detected. 73% of the USA population are found to have vitamin D insufficiency, moreover, with figures almost reaching the upper limit < 30 ng/mL. [15, 1517-1524]. In Canada insufficient
25 (OH)D serum level was detected in almost 93% of population of the same age [16, 2066-2073].
In our research the lowest vitamin D serum concentration (< 10 ng/mL) was detected in 23,9% of males. It corresponds to the research data of the European countries — vitamin D serum level was lower than 10-12 ng/mL in 7-27% of population [17, 1079-1089].
Fig 2. - Pearson correlation between vitamin D in the diet and age
In turn, the research data of the Northern countries show that in 8-17% of the population 25 (OH) D serum concentration is not higher 20 ng/mL [18, 62-83]. In our research vitamin D level was markedly insufficient in 51,5% of men (< 20 ng/mL). It is likely due to the higher average age of the participants compared to the analogous study. According to the research data from our neighboring country Lithuania, more than half of men had vitamin D deficiency in winter (12-30 ng/mL), 43% were found to have deficiency (< 12 ng/mL), and only 1,7% had vitamin D in sufficient concentration (> 30 ng/mL) [19, 558-588].
In our research only 6% of men (n=8) had vitamin D level within normal limits, moreover, it was close to the lowest limit. The highest vitamin D serum level was detected in 1 man (43,2 ng/mL), and that
was only slightly higher than the lower limit (>30-70 ng/mL). However, the mean serum 25 (OH)D level was 16,9 ± 7,6 ng/mL (2,2-43,2 ng/mL), that was lower compared to the research data from the USA. (23,9 ng/mL) [20, 76-83] and the Northern countries (18,7 ng/mL) [21, 207-210]. High vitamin D deficiency is related to the insufficient exposure to sunlight. None of the research participants were taking vitamin D supplements, that was one of the objective indicators. Vitamin D serum level was analyzed seasonally — in spring and fall. The research participants, whose blood test was made in summer were included into the fall group. Consequently, the men, whose vitamin D serum level was measured in winter comprised the spring group. It was very important to compare vitamin D level after winter, when sunlight exposure generally is low and 7-dehydro-
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Dietary sources of vitamin D and seasonal variations of 25 (OH) vitamin D serum levels in men over 45 years of age in Latvia
cholecalciferol absorption by the skin is minimal. The wavelength of UV should be 290-315 nanometers to provide for the natural vitamin D synthesis in the skin. In the Northern latitudes, as well as in Latvia, sunlight is not intensive enough to stimulate vitamin D production from October to March. Vitamin D3 synthesis in the skin is triggered due to UVB radiation. In the course of absorption, the B ring of provitamin D3 undergoes a photolysis reaction and is transformed into D3 previtamin. Since this substance is thermodinamically unstable, the process of izomerization of 3 conjugated double bonds occurs extremely fast and D3 vitamin is produced.
We received the expected results: vitamin D serum level in fall was higher 17,5 ± 7,6 ng/mL (4,843,2 ng/mL) than in spring 15,8 ± 7,7 ng/mL (2,239,3 ng/mL). We would like to mention one research conducted in England, that included 1766 participants over 65 years of age, who lived in both private houses and flats. 25 (OH) D serum concentration was lower in males (15,2 ng/mL) and females (14,7 ng/mL), who lived in flats, compared with those males (22,5 ng/mL) and females (19,4 ng/mL) living in private houses.
According to the literature data, vitamin D serum level is lower with age. It occurs due to the decreased vitamin D synthesis in the skin, as well as the impaired vitamin D absorption through the gastrointestinal tract and hydroxylation in the liver and kidneys. In our research we found a statistically significant indirect correlation between the age and vitamin D serum level. Many studies have been conducted in order to determine vitamin D level in elderly population in Europe. For example, we can name the famous SENECA research comprised 12 European countries. It was carried out to determine the relation between the dietary sources and health of persons of advancing age. It was concluded that in general 36% of males and 47% of females had insufficient 25 (OH)D serum concentration (< 12 ng/mL). Surprisingly enough, 50% of the Netherlands population were found to have 25 (OH) D serum concentration lower than 20 ng/mL [22, 2058-2065].
The analysis and comparison of the USA research data from two studies conducted between years
1988-1994 and 2001-2004 showed the extremely low 25 (OH) vitamin D serum concentration in all age groups [23, 26-32].
No statistically significant correlation between vitamin D serum level and BMI was found in our research. However, in the published literature there is data on the association between high BMI and low vitamin D serum level. [24, 796-804]. We did not find any correlation between the intake of vitamin D and BMI. It is likely due to the low number of obese subjects included. BMI in case of obesity is
> 30 kg/m2, while the average BMI of our research subjects was 28,1 kg/m2. Statistically significant correlation is found in case of BMI over 40 kg/m2. In our research there was only one subject with high BMI — 41,5 kg/m2, in other obese subjects (26,6%) BMI was close to the lower limit of obesity (> 30 kg/m2).
Undoubtedly, vitamin D is essential to the human body. It is the main prophylactic factor for the muscle and bone health. Therefore, in the recent years the link between a diet and health is understood better -a promising prophylactic measure for the public health. Elimination of unhealthy eating habits and nutrient deficiencies is one of the priorities of the World Health Organization stated in the WHO Global Action Plan for 2008-2013 years. The high number of new interesting research papers shows the significance of vitamin D in prevention of many diseases, including cardiovascular, immune diseases, diabetes, asthma, multiple sclerosis and different forms of cancer.
The research conducted in Tartu, Estonia in 2006 included 367 subjects (200 females, 167 males) with the average age 48,9 ± 12,2 years (ranging from 25 and 70 years). The mean vitamin D serum level in winter was found to be 17,5 ± 6 ng/mL, and — 24,2 ± 7,4 ng/mL in summer. Vitamin D insufficiency in winter was detected in 73% of subjects, deficiency was found in 8% of males, while in summer only 29% had vitamin D insufficiency and deficiency in 1%, consequently. The data of our research have been similar. Only 1/3 of the Estonian population had a sufficient vitamin D serum level, and merely in 3% it was found to be over the optimal norm
> 30 ng/mL. Even though the average vitamin D
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Section 1. Clinical medicine
concentration is summer reached 24 ng/mL, in almost 2/3 of the population it was still suboptimal (30 ng/mL). [25, 9-22; 16, 2066-2073]. If a person is obese or suffers from some kidney or liver disorders, the effect of vitamin D is impaired, thus the intake of vitamin D could be increased. However, vitamin D overdose is not desirable either. In case of vitamin D hypervitaminosis muscle pain, weakness, headache, fatigue, increased Calcium serum level, constipation, and kidney stones are observed, as well as Calcium deposits on the heart valves, in the heart, blood-vessels and kidneys. Therefore, vitamin D serum level should be measured prior to taking vitamin D itself or its supplements.
It has been recommended by many studies to take vitamin D containing supplements, dietary supplements and vitamin D containing products. One of the most effective, and pleasant to some individuals, ways to get vitamin D is sunbathing. One should bear in mind that sunscreens applied on the skin decrease vitamin D synthesis, therefore, prolonged exposure to sunlight may lead to sunburns. Optimal vitamin D dose can be produced after 2030 minutes of sun exposure to the face, arms and legs. In our research we have found a statistically significant correlation between vitamin D serum level and vitamin D amount in diet. Sun exposure, undoubtedly, is very important to increase vitamin D level, but dietary sources also influence vitamin D level.
A dietary questionnaire was used to detect the frequency of certain product consumption by the research subjects within last six months. By this method we received information on the amount of the consumed food, trade mark of the products, methods of cooking, and terms of consumption. The method is relatively inaccurate, very subjective, but anyway, can provide with an overall impression. Some subjects had morbid obesity (BMI > 41 kg/m2), therefore, the energy intake exceeded normal limits significantly. According to the Latvian comprehension food consumption research in 2007-2009 the mean result of the total daily energy intake from the diet in men was 2234 kcal/d. The amount of energy taken by adult men relatively lowers with age, that was also confirmed by our research.
The data of our research show that the most of vitamin D men consumed with herring (140 IU/d) and salmon (104 IU/d). According to the literature sources, fatty sea fish is the richest in vitamin D, it was also confirmed by our results. In turn, only 6 IU/d was consumed with mackerel, since it was eaten very seldom (once a month or even less).
Dairy products — milk, kefir, sour cream did not provide any significant amount of vitamin D. One liter of milk is required daily to provide for 20 IU of vitamin D, besides, it is only 5% of daily recommended dose (400 IU/d). Fatty dairy products such as butter, is considered to be a good source of vitamin D. Our research subjects received 8 IU of vitamin D with 20 g of butter. 69,4% of subjects consumed butter, that, undoubtedly, was not the main vitamin D source. Due to high fat content (80%) excessive butter intake may lead to increase of serum cholesterol level. 5 IU daily was consumed with sweet cream, that was insufficient, too. With eggs were consumed 20 IU of vitamin D daily. Consumption of eggs is common and frequent in men.
Vitamin D fortified products are widespread in the United States. The wide range of the products is available: dairy products (yogurt, milk, and cheese), juice (orange), grain products (bread, cereals, biscuits, crackers). In Latvia there are the products that are enriched with vitamin D (drinking yogurts, canola oil, butter, margarine, cheese), but the vitamin D level in these is insignificant (~ 0,8 pg/100 ml).
Since fish oil and fatty fish are very rich in vitamin D, their regular consumption (2-3 times a week) allows to retain vitamin D serum level within normal limits. In lower concentrations vitamin D is also found in egg yolk, caviar, liver, grains, grain shoots and parsley. Furthermore, some types offish, for example mackerel, herring, salmon and trout contain the recommended daily amount of vitamin D in 1 portion (120 g.). In case of low vitamin D serum level (< 30 ng/mL), it is required to take 8001000 IU of vitamin D supplement daily [26, 66-81].
Conclusion
1. Vitamin D deficiency and insufficiency are common in the Latvian males of advancing age — 94,1%.
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Dietary sources of vitamin D and seasonal variations of 25 (OH) vitamin D serum levels in men over 45 years of age in Latvia
2. Vitamin D serum level directly correlates with the amount of the consumed food. No statistically reliable correlation has been found between vitamin D level, vitamin D in diet, and BMI, but it indirectly correlated with age.
3. It is essential for males over 45 years of age to take vitamin D supplement 800-1000 IU/daily, with
prior detection 25 (OH)D serum level (<30 ng/mL). It is strongly recommended for the Latvian population to be sufficiently exposed to the direct sunlight from March to November.
4. Further research with a larger number of participants is required to prove and confirm the significance of the diet in case of vitamin D deficiency.
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Ilhom Hayitov, assistant, department of Surgical disease for GP Tashkent Medical Academy E-mail: ilhom.med79@mail.ru.
The quality of life of patients with postoperative and ventral hernias and abdominal obesity before and after surgery
Abstract: Treatment treatment of postoperative and ventral hernias in patients with obesity affects not only surgical but also a number of social problems. The quality of life of patients in the late period after the removal of the ventral hernia is different from the average population indicators and does not depend on the chosen method.
Keywords: postoperative and ventral hernias, quality of life, anterior abdominal wall, abdominoplasty.
Relevance. The social significance of the problem and surgical treatment of postoperative and ventral hernias (POVH) exacerbates the fact that the largest number of patients with age ranging from 40 to 60 years, i. e., working age [3, 55-56]. 46% of patients operated on for POVH engaged in physical labor, and are in need of total rehabilitation [4, 138]. Among patients women prevail — 67.8% [5, 6263]. The most common hernias occur in individuals
with a cone-shaped [6, 3-7] and spherical shape of the abdomen, mostly located in the cut hypogastric region [8, 14-15].
Contributing factors of recurrence POVH is obesity [8, 14]. Patients with obesity POVH varying degrees ranging from 50 to 70% [7, 37-39]. Of all patients with postoperative and ventral hernias and in 34% of patients had morbid obesity in 23% of cases had recurrent hernia [14, 199-201]. With
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