Rates of bone loss in postmenopausal women randomly assigned to one of two dosages of vitamin D.

We conducted a study to determine whether increasing vitamin D intake above the recommended dietary allowance (RDA) of 5.0 micrograms (200 IU)/d reduces bone loss in healthy postmenopausal women residing at latitude 42 degrees N. In this double-blind, randomized 2-y trial, we enrolled 247 healthy ambulatory postmenopausal women who consumed an average of 2.5 micrograms (100 IU) vitamin D/d in their usual diets. The women were given either 2.5 micrograms (100 IU) or 17.5 micrograms (700 IU) vitamin D/d. All women received 500 mg supplemental calcium per day as citrate malate. Duplicate hip and spine and single whole-body scans were performed by dual-energy x-ray absorptiometry at 6-mo intervals selected to flank the periods when 25-hydroxycholecalciferol (calcidiol) concentrations are highest (summer/fall) and lowest (winter/spring). Plasma calcidiol and serum osteocalcin were measured in these seasons in year 1. Both treatment groups lost bone mineral density from the femoral neck, but the 17.5-micrograms group lost less than (-1.06 +/- 0.34%; mean +/- SE) the 2.5-micrograms group (-2.54 +/- 0.37%, P = 0.003). Seventy percent of the benefit each year occurred in winter/spring and 30% in summer/fall. Changes in spinal and whole-body bone densities did not differ by treatment group and were minimal after 2 y. Serum osteocalcin and plasma calcidiol (2.5-micrograms group only) fluctuated with season. In conclusion, in healthy, calcium-supplemented, postmenopausal women residing at latitude 42 degrees N, an intake of 5.0 micrograms (200 IU) vitamin D/d is sufficient to limit bone loss from the spine and whole body but it is not adequate to minimize bone loss from the femoral neck.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of illness behaviour on the apparent relationship between physical and mental disorders.

Evidence for associations between organic disease and psychopathology is reviewed and it is concluded that some of this is determined by complaint and consultation behaviours. The concept of illness behaviour is described. The Self Care Assessment Schedule (SCAS) is a new measure of illness behaviour and has been used to provide an independent assessment of psychiatric day patients, gynaecology and surgical outpatients. Only weak positive correlations were found between SCAS scores and mental illness, measured using the General Health Questionnaire (GHQ). Subjects with organic pathology differed little from those without organic pathology, with regard to SCAS and GHQ scores. However SCAS and GHQ scores were more highly correlated in those without organic pathology. It is concluded that claimed associations between physical disease and psychopathology should be based on objective evidence rather than subjective complaints and that this should be found across the entire spectrum of illness behaviour.

Maintenance of pregnancy in a home parenteral nutrition patient.

A case is reported of successful conception and completion of pregnancy in a patient with intestinal failure due to Crohn's disease, nourished entirely by home parenteral nutrition. The nutritional regimen included both dextrose and lipid as calorie sources, together with synthetic amino acids and appropriate additives. Nutritional status was monitored by blood biochemistry, anthropometry, urinary nitrogen losses, and measured resting energy expenditure. Obstetric progress was monitored by standard methods, including abdominal ultrasound, maternal weight gain, and measurement of plasma hormone levels. Herein, particular attention is given to the use of intravenous lipid in pregnancy.

Influence of amniotic fluid volume on lecithin estimation in prediction of respiratory distress.

One hundred samples of amniotic fluid were obtained by amniocentesis from 82 patients at different stages of normal and abnormal pregnancies. The concentration of lecithin was estimated together with the volume of the amniotic fluid, using the dilution technique. Thus the total quantity of lecithin in any amniotic sac could be calculated. While confirming the findings of others that concentrations of lecithin below 3.5 mg/100 ml in the liquor immediately before delivery suggested that the baby was likely to develop respiratory distress syndrome, we found that in borderline cases the total amount of lecithin in the sac was of greater prognostic significance than the lecithin concentration.

Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women.

OBJECTIVES: To determine whether relative vitamin D deficiency during the winter months contributes to age-related bone loss and whether rates of change in hard- and soft-tissue mass vary during the year. DESIGN: Double-blind, placebo-controlled, 1-year trial in 249 women in which equal numbers of women were randomized to either placebo or 400 IU of vitamin D daily. All women received 377 mg/d of supplemental calcium largely as calcium citrate malate. PATIENTS: Healthy, ambulatory postmenopausal women with usual intakes of vitamin D of 100 IU/d. MEASUREMENTS: Duplicate spine and whole-body scans were done by dual energy x-ray absorptiometry at 6-month intervals that were timed to periods when 25-hydroxyvitamin D levels were highest and lowest. Period 1 was June-July to December-January and period 2 was December-January to the next June-July. Serum parathyroid hormone and plasma 25-hydroxyvitamin D levels were measured during periods 1 and 2. MAIN RESULTS: In the placebo group, spinal bone mineral density increased in period 1, decreased in period 2, and sustained no net change. Women treated with vitamin D had a similar spinal increase in period 1 (1.46% compared with 1.40% in placebo), less loss in period 2 (-0.54% compared with -1.22%, CI for the difference, 0.05% to 1.31%, P = 0.032) and a significant overall benefit (0.85% compared with 0.15%, CI for the difference, 0.03% to 1.37%, P = 0.04). In period 2, 25-hydroxyvitamin D levels were lower and parathyroid hormone levels were higher in the placebo than in the vitamin D group. Whole-body lean and fat tissue and bone mineral density varied during the year but did not change overall. CONCLUSIONS: At latitude 42 degrees, healthy postmenopausal women with vitamin D intakes of 100 IU daily can significantly reduce late wintertime bone loss and improve net bone density of the spine over one year by increasing their intake of vitamin D to 500 IU daily. A long-term benefit of preventing vitamin D insufficiency in the winter seems likely although it remains to be shown. Observed changes in bone as well as in fat and lean tissue appear to be related to season.