Use of calcium, folate and vitamin D3-fortified milk for 6 months improves nutritional status, but not bone mass or turnover, in a group of Australian aged care residents

Abstract

In residential care, inadequate calcium and folate intakes and low serum vitamin D (25(OH)D) concentrations are common. We assessed whether daily provision of calcium, folate, and vitamin D3–fortified milk for 6 months improved nutritional status (serum micronutrients), bone quality (heel ultrasound), bone turnover markers (parathyroid hormone, C-terminal collagen I telopeptide, terminal propeptide of type I procollagen), and=or muscle strength and mobility in a group of Australian aged care residents. One hundred and seven residents completed the study (mean (SD) age: 79.9(10.1) years; body weight: 68.4 (15.4) kg). The median (interquartile range) volume of fortified milk consumed was 160 (149) ml=day. At the end of the study, the median daily vitamin D intake increased to 10.4 (8.7) µg (P<.001), which is 70% of the adequate intake (15 µg); and calcium density (mg=MJ) was higher over the study period compared with baseline (161 ±5 mg=MJ vs. 142 ± 4mg=MJ, P<.001). Serum 25(OH)D concentrations increased by 23 ± 2nmol=L (83 (107)%, P<.001), yet remained in the insufficient range (mean 45_2nmol=L). Consumption of greater than the median intake of milk (160ml=day) (n¼54, 50%) increased serum 25(OH)D levels into the adequate range (53_2nmol=L) and reduced serum parathyroid hormone by 24% (P=.045). There was no effect on bone quality, bone turnover markers, muscle strength, or mobility. Consumption of fortified milk increased dietary vitamin D intake and raised serum 25(OH)D concentrations, but not to the level thought to reduce fracture risk. If calcium-fortified milk also was used in cooking and milk drinks, this approach could allow residents to achieve a dietary calcium intake close to recommended levels. A vitamin D supplement would be recommended to ensure adequate vitamin D status for all residents.