Nutrition Updates

USE OF VITAMIN D IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE Lehouck A, Mathieu C, Carremans C, Baeke F, Verhaegen J, Van Eldere J, Decallonne B, Bouillon R, Decramer M, and Janssens W. High doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2012;156:105114. Low levels of vitamin D are associated with increased inammation, impaired immune response, and respiratory tract infections. Vitamin D deciency is commonly seen in patients with both tuberculosis and chronic obstructive pulmonary disease (COPD). Vitamin D therapy is known to be benecial in the management of tuberculosis, but it is not known to what degree vitamin D therapy may aect COPD treatment. Although COPD is primarily characterized by airway inammation and impaired lung function, the disease also has extrapulmonary eects such as deep venous thrombosis, systemic inammation, osteoporotic fractures, and muscle weakness. Vitamin D deciency in patients with COPD is associated with increased risk for these extrapulmonary symptoms. The study recently reported by Lehouck et al. examined the ecacy of vitamin D supplementation in the treatment of COPD. Patients over the age of 50 years (N = 182) with moderate to severe COPD were enrolled in a randomized-controlled, double-blind trial designed to assess the ability of a 1-year treatment with high-dose vitamin D to reduce exacerbations of COPD. At baseline, one group of participants was already taking lowdose vitamin D for osteoporosis; thus, randomization into the high-dose-supplement trial was performed separately for vitamin D-nave individuals and vitamin D supplement users. Participants in the intervention group received a monthly oral dose of D-Cure, which contained 100,000 IU cholecalciferol (4 mL suspension). Participants in the placebo group received 4 mL peanut oil. Outcome measures included time to rst exacerbation, exacerbation rate, quality of life, time to hospitalization, and death. Physiological measures included serum 25-hydroxyvitamin-D levels (25[OH]D), plasma cathelicidin levels, FEV1 (forced expiratory volume in one second), and bacterial levels in morning sputa. Baseline levels of 25-(OH)D did not dier between the placebo group and the high-dose-supplementation group. Over the 1 year supplementation period, serum
doi:10.1111/j.1753-4887.2012.00474.x Nutrition Reviews Vol. 70(3):E1E2

levels of 25-(OH)D were signicantly elevated in the supplementation group relative to the placebo group. During the study, 229 exacerbations occurred in the high-dose-supplementation group and 239 exacerbations occurred in the placebo condition. High-dose supplementation was not associated with increased time to rst exacerbation, reduced number of exacerbations, reduction in mortality, improved quality of life, or improved FEV1. When looking at baseline vitamin D status in participants with severe vitamin D deciency (<10 ng/mL 25-(OH)D), exacerbations were signicantly reduced in participants receiving high-dose vitamin D (n = 15) relative to placebo (n = 15). In this randomized-controlled trial, high-dose vitamin D therapy did not improve clinical management of COPD in COPD patients. Analysis of a small subgroup of participants showed a reduction of exacerbations following 1 year of high-dose vitamin D in patients who had very low baseline levels of 25-(OH)D. The authors stress that this observation was made in a small subsample and should be treated as a hypothesis-generating observation rather than as a recommendation for patient management. Comment: In an accompanying editorial, Drs. Gold and Manson discuss several mechanisms through which vitamin D may exert benecial eects in COPD. Vitamin D upregulates cathelicidins (antimicrobial peptides), which may protect against bacterial and viral infections, and may also aect airway remodeling. They discuss the Vitamin D and Omega-3 Trial (VITAL), an ongoing, large-scale, clinical trial investigating the long-term eects of 2,000 IU/d vitamin D on cardiovascular disease and cancer, and the potential of this study to provide greater insight into the relationship between vitamin D status and lung health. Comment: Gold DR and Manson JE. Severe vitamin D deciency: A prerequisite for COPD responsiveness to vitamin D supplementation? Ann Intern Med. 2012;156: 156157. PREVALENCE OF OBESITY IN THE US POPULATION 19992010 Flegal KM, Carroll MD, Kit BK, and Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 19992010. JAMA. 2012; doi: 10.1001/jama.2012.39
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AND Ogden CL, Carroll MD, Kit BK, and Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 19992010. JAMA. 2012; doi: 10.1001/jama.2012.40 Rates of obesity in the United States increased among adults and children in the 1980s and 1990s.These observed increases have led to major changes in public health policy and education eorts with the aim of reducing or reversing this trend. While some analyses appear to predict an ongoing upward trend in US obesity rates, other studies suggest the actual prevalence of obesity may be stabilizing. Two new reports from the National Center for Health Statistics compare the current prevalence of obesity (20092010) with the observed prevalence of obesity in the previous decade in US adults (Flegal et al., 2012) and in children and adolescents (Ogden et al., 2012). Data were extracted from the 20092010 National Health and Nutrition Examination Survey (NHANES 20092010) for 5,926 adult men and women and 4,111 children and adolescents (birth through age 19 years). Data for adults were compared with NHANES 19992000 data, and data for children were analyzed across the entire time range from NHANES 19992000 to the present NHANES 20092010 (surveys: 19992000, 20012002, 20032004, 20052006, 20072008, and 20092010). In adults, the primary outcome measures were mean BMI and prevalence of obesity (dened as BMI 30 kg/m2). The primary outcome measure in children between 0 and 2 years of age was weight-for-recumbent length (high weight in this group is dened as at or above the 95th percentile on the 2000 growth charts of the Centers for Disease Control and Prevention [CDC]). Weight status for children and adolescents was dened using BMI, and obesity was dened as a BMI score at or above the sexspecic 95th percentile on the CDCs 2000 BMI-for-age

growth charts. Prevalence of obesity was analyzed by sex, age, and race/ethnicity in adults and children. Among adults in 20092010, the overall mean BMI was 28.7 for both men and women. Among men, the overall prevalence of obesity was 35.5%, which represented an increase in prevalence over the entire 12-year period, but no increase from 20032008 to 20092010. Among women, the overall prevalence of obesity in 20092010 was 35.8% and did not change from 2003 2008. When analyzed by race/ethnicity, rates of obesity increased signicantly for non-Hispanic black women and for Mexican American women. In children, 9.7% of infants and toddlers had a high weight-for-recumbent length, and 16.9% of children and adolescents aged 2 years through 19 years were classied as obese. There were no dierences in overall prevalence of obesity between 20072008 and 20092010. There was a signicant increase in the prevalence of obesity in males from 1999 to 2010, but this was not observed in females. When analyzed by race/ethnicity, rates of obesity increased signicantly for non-Hispanic black males. In the two recently reported analyses, overall rates of obesity appear to be leveling o, rather than continuing to increase, with some changes in the rates of obesity in non-Hispanic black women and boys, and in Mexican American women. These data are in agreement with data from Sweden, Switzerland, and Spain, suggesting that rates of obesity in adults are slowing. The data on global rates of obesity in children and adolescents is more varied, and suggest an increase in some regions (Canada), a plateau in other regions (Australia and France), and a decrease in yet other areas (Switzerland). The etiology of the recent global increases in rates of obesity is still poorly understood. At present, population studies suggest that the dramatic increases in BMI seen in the 1980s and 1990s may be at a plateau. KE D'Anci

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