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Associations Between Vitamin D Status, Adiposity, and Inflammatory Biomarkers in Young Women (18 – 30 Years)

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Associations Between Vitamin D Status, Adiposity, and Inflammatory Biomarkers in Young Women (18 – 30 Years) University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations Dissertations and Theses Summer November 2014 Associations Between Vitamin D Status, Adiposity, And Inflammatory Biomarkers In Young Women (18 – 30 Years) Adolphina Addo-Lartey University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_2 Part of the Women's Health Commons Recommended Citation Addo-Lartey, Adolphina, "Associations Between Vitamin D Status, Adiposity, And Inflammatory Biomarkers In Young Women (18 – 30 Years)" (2014). Doctoral Dissertations. 150. https://doi.org/10.7275/6054079.0 https://scholarworks.umass.edu/dissertations_2/150 This Open Access Dissertation is brought to you for free and open access by the Dissertations and Theses at ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. ASSOCIATIONS BETWEEN VITAMIN D STATUS, ADIPOSITY, AND INFLAMMATORY BIOMARKERS IN YOUNG WOMEN (18 – 30 YEARS) A Dissertation Presented by ADOLPHINA A. ADDO-LARTEY Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY SEPTEMBER 2014 Public Health Nutrition © Copyright by Adolphina A. Addo-Lartey 2014 All Rights Reserved ASSOCIATIONS BETWEEN VITAMIN D STATUS, ADIPOSITY, AND INFLAMMATORY BIOMARKERS IN YOUNG WOMEN (18 – 30 YEARS) A Dissertation Presented by ADOLPHINA A. ADDO-LARTEY Approved as to style and content by: _______________________________________ Dr. Alayne Ronnenberg, Committee Chair _______________________________________ Dr. Elizabeth Bertone-Johnson, Committee Member _______________________________________ Dr. Richard Wood, Committee Member _______________________________________ Dr. Carol Bigelow, Committee Member ______________________________ Dr. Nancy L. Cohen, Head Department of Nutrition DEDICATION To God be the Glory, Great Things He hath done… Greater Things He will do. ACKNOWLEDGEMENTS I am grateful to my advisor and committee chair, Dr. Alayne Ronnenberg, for her guidance and encouragement as I gathered research ideas for my dissertation. Her immense input during our progress/review meetings helped shaped my research questions and writing of manuscripts. I am thankful to Dr. Elizabeth Bertone Johnson and Dr. Alayne Ronnenberg, Principal Investigators of the UMass Amherst Vitamin D Status Study, for making the study data available for my use. I would also like to thank all members of my committee; Dr. Elizabeth Bertone-Johnson, Dr. Richard Wood, and Dr. Carol Bigelow, for sharing their time and expertise over the course of this project. My sincere appreciation goes to all the women who volunteered for the UMass Amherst Vitamin D Status Study; as well as Dr. Sofija Zagarins, Biki Takashima- Uebelbör, and Joycelyn Faraj for their assistance with data collection. Last but not least, I would like to express my heartfelt gratitude to my amazing husband (Dr. Michael Lartey), as well as all my family and friends for their constant encouragement and support. Without you to cheer me on, this journey would have seemed even more arduous. I am so very thankful for all of you, God richly bless you. v ABSTRACT ASSOCIATIONS BETWEEN VITAMIN D STATUS, ADIPOSITY, AND INFLAMMATORY BIOMARKERS IN YOUNG WOMEN (18 – 30 YEARS) SEPTEMBER 2014 ADOLPHINA A. ADDO-LARTEY, B.Sc., UNIVERSITY OF GHANA, LEGON Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Supervised by: Dr. Alayne Ronnenberg Calcium and vitamin D intakes have been linked with reduced adiposity in older adults and in obese women (body mass index, BMI, ≥ 30 kg/m2). However, very little is known about the extent of these associations in apparently healthy, non-obese, young women. Emerging research also suggest that vitamin D insufficiency (serum 25-hydroxyvitamin D, 25-OHD, < 75 nmol/L) and increased adiposity may be associated with higher levels of inflammatory biomarkers in obese/older adults, and chronically ill patients. We conducted a cross-sectional analysis among 270 (18- to 30-year old) female participants in the UMass Amherst Vitamin D Status Study (n = 270) to assess the extent to which dietary intakes of calcium and vitamin D are associated with obesity markers. We also evaluated the association between serum 25- OHD concentrations and both adiposity and inflammatory biomarkers. Study participants were mostly Caucasians (84.5%) with normal BMI, although about half of women had high adiposity (total body fat ‘TBF’≥ 32%). Women reporting adequate intakes of calcium (≥ 1000 mg/day) but low intakes of vitamin D (< 600 IU/day) were more than twice as likely to have a high percentage of TBF compared to women with adequate intakes of both calcium and vitamin D. In addition, women vi with lower calcium intake from supplements were twice as likely to have a waist circumference ≥ 80 cm (OR = 2.04; 95% CI: 1.04 – 3.99) compared to women in the highest tertile of calcium intake. The magnitude of this association is important since among young women 18-30 years old, a waist circumference greater than 80 cm indicates central obesity and suggests increased visceral adiposity, which contributes to hyperlipidemia and other obesity-related chronic conditions. Among all women, total vitamin D, food vitamin D, and supplemental vitamin D intake were not associated with serum 25-OHD concentration (P > 0.05). However, among supplement users only, intake of vitamin D supplements was positively correlated with serum 25-OHD levels (ß = 0.03 ± 0.01 nmol/L, P = 0.05). These findings support the notion that serum levels of 25-OHD are influenced by other factors besides the vitamin D content of foods, including the use of vitamin D supplements. Serum 25- OHD concentration tended to be correlated with hs-CRP levels (r = 0.14, P = 0.06), but was not significantly associated with adiposity and inflammatory biomarkers. Among women with low 25-OHD (< 75 nmol/L), serum 25-OHD level was inversely associated with IL-2 and GM-CSF concentrations, and marginally associated with IL- 6 and IL-7 concentrations. Additional prospective studies in more heterogeneous populations will help to characterize the relationship between vitamin D status, inflammation and obesity. vii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS .................................................................................................v ABSTRACT………. ........................................................................................................ ..vi LIST OF TABLES.. .......................................................................................................... xii LIST OF FIGURES ...........................................................................................................xv INTRODUCTION ...............................................................................................................1 CHAPTER 1. LITERATURE REVIEW ................................................................................................3 1.1 Background on Calcium and Vitamin D ............................................................3 1.1.2 Absorption, Transport, Metabolism and Excretion.............................6 1.1.2.1 Calcium Absorption and Transport ......................................6 1.1.2.2 Calcium Metabolism and Excretion.....................................9 1.1.2.3 Vitamin D Absorption and Transport ................................10 1.1.2.4 Vitamin D Metabolism and Excretion ...............................11 1.1.3 Functions and Mechanisms of Action...............................................12 1.1.4 Assessment of Nutritional Status ......................................................13 1.1.5 Food Sources and Recommended Dietary Intakes ...........................17 1.2 Relationship between Dietary Calcium, Vitamin D and Adiposity .................23 1.2.1 Dietary Calcium and Adiposity ........................................................23 1.2.2 Dietary Vitamin D and Adiposity .....................................................33 1.3 Relationship between Adiposity and Serum 25-OHD Concentration .............34 1.4 Cytokines and Immune Function .....................................................................40 1.4.1 C-Reactive Protein and Inflammation ..............................................45 1.5 Vitamin D and Inflammation ...........................................................................49 1.6 Relationship between Serum 25-OHD, Adiposity and Inflammation .............50 viii 2. SPECIFIC AIMS AND HYPOTHESES .......................................................................56 2.1 Calcium, Vitamin D Intakes and Adiposity in Young Women .......................56 2.1.1 Specific Aims ....................................................................................56 2.1.2 Hypotheses ........................................................................................56 2.2 Serum 25-OHD Concentration and Adiposity in Young Women ...................57 2.2.1 Specific Aims ....................................................................................57 2.2.2 Hypotheses ........................................................................................58 2.3 Serum 25-OHD, Adiposity and Inflammation in Young Women ...................58 2.3.1 Specific Aims ....................................................................................58 2.3.2 Hypotheses
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