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  • Original Article
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Minerals, trace elements, Vit. D and bone health

Dietary vitamin A intake and bone health in the elderly: the Rotterdam Study

European Journal of Clinical Nutrition volume 69, pages 1360–1368 (2015)Cite this article

Subjects

A Corrigendum to this article was published on 02 December 2015

This article has been updated

Abstract

Background/Objectives:

High vitamin A intake may be associated with a decreased bone mineral density (BMD) and increased risk of fractures. Our objectives were to study whether dietary intake of vitamin A (total, retinol or beta-carotene) is associated with BMD and fracture risk and if associations are modified by body mass index (BMI) and vitamin D.

Subjects/Methods:

Participants were aged 55 years and older (n=5288) from the Rotterdam Study, a population-based prospective cohort. Baseline vitamin A and D intake was measured by a food frequency questionnaire. BMD was measured by dual-energy X-ray absorptiometry at four visits between baseline (1989–1993) and 2004. Serum vitamin D was assessed in a subgroup (n=3161). Fracture incidence data were derived from medical records with a mean follow-up time of 13.9 years.

Results:

Median intake of vitamin A ranged from 684 retinol equivalents (REs)/day (quintile 1) to 2000 REs/day (quintile 5). After adjustment for confounders related to lifestyle and socioeconomic status, BMD was significantly higher in subjects in the highest quintile of total vitamin A (mean difference in BMD (95% confidence interval (CI))=11.53 (0.37–22.7) mg/cm2) and retinol intake (mean difference in BMD (95% CI)=12.57 (1.10–24.05) mg/cm2) than in the middle quintile. Additional adjustment for BMI diluted these associations. Fracture risk was reduced in these subjects. Significant interaction was present between intake of retinol and overweight (BMI >25 kg/m2) in relation to fractures (P for interaction =0.05), but not BMD. Stratified analysis showed that these favourable associations with fracture risk were only present in overweight subjects (BMI >25 kg/m2). No effect modification by vitamin D intake or serum levels was observed.

Conclusions:

Our results suggest a plausible favourable relation between high vitamin A intake from the diet and fracture risk in overweight subjects, whereas the association between vitamin A and BMD is mainly explained by BMI.

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Change history

  • 02 December 2015

    This article has been corrected since Advance Online Publication and a corrigendum is also printed in this issue.

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Acknowledgements

OHF, JCK-de J and EAL de J work in ErasmusAGE, a centre for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA. Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. Dr F Rivadeneira received a grant from the Netherlands Organization for Health Research and Development (VIDI 016.136.367). AH designed research, EAL de J, LB and NC-O analysed data, EAL de J and JCK-de J wrote the paper and OHF, AGU, FR, JCK-de J and MCZ had primary responsibility for the final content. The contribution of inhabitants, general practitioners and pharmacists of the Ommoord district to the Rotterdam Study is gratefully acknowledged. The Rotterdam Study is supported by the Erasmus MC University Medical Centre and Erasmus University Rotterdam; The Netherlands Organisation for Scientific Research (NWO; project number 022.002.023 for the presented research); The Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); The Netherlands Genomics Initiative (NGI); the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam.

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Author notes

  1. F Rivadeneira and M C Zillikens: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

    E A L de Jonge, N Campos-Obando, L Booij, A G Uitterlinden, F Rivadeneira & M C Zillikens

  2. Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands

    E A L de Jonge, J C Kiefte-de Jong, O H Franco, A Hofman & A G Uitterlinden

  3. Department of Global Public Health, Leiden University College, The Hague, The Netherlands

    J C Kiefte-de Jong

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  1. E A L de Jonge
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de Jonge, E., Kiefte-de Jong, J., Campos-Obando, N. et al. Dietary vitamin A intake and bone health in the elderly: the Rotterdam Study. Eur J Clin Nutr 69, 1360–1368 (2015). https://doi.org/10.1038/ejcn.2015.154

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