Discovering the obvious, damaging the defenseless

Abstract

Dear Editor: In their recent article, Payne et al [1] showed that vitamin D intakes below the current 600 IU/d recommended by the Food and Nutrition Board for the elderly are correlated with brain lesions. They rang the alarm bell by concluding that vitamin D supplementation may cause those lesions, without controlling for place of residence. Although I am aware of no studies that specifically compare vitamin D intakes between free-living and institutionalized elders, the free-living demented are notorious for their eccentric diets. For example, Marshall et al [2] found 83% of communitydwelling elderly had vitamin D intakes below Food and Nutrition Board recommendations. I cannot imagine that community-dwelling elderly demented patients would eat more fatty fish or drink more fortified milk than communitydwelling elderly in general. Certainly, the diet of demented patients must improve with institutionalization, when dieticians usually oversee the menu. Furthermore, as Payne et al point out, the incidence of calcific brain lesions and severity of dementia are highly associated. Certainly those with severe dementia are more likely to be institutionalized than those with mild dementia. Thus, those with severe dementia are more likely to be institutionalized, likelier to have brain lesions, and likelier to have a better diet. Without controlling for place of residence, I suspect all Payne et al discovered was that the elderly with brain lesions are more likely to be both institutionalized and have a better diet. Two recent studies, not discussed by Payne et al, showed that higher 25(OH)D levels were associated with better, not worse, cognitive performance [3,4]. A recent review concluded that vitamin D deficiency even among the institutionalized elderly is the rule, not the exception [5]. One can only imagine how pathetic the situation is in community-dwelling demented individuals. Furthermore, a glut of recent studies indicates low vitamin D levels are associated with a litany of chronic diseases. I worry that all Payne et al did was to imperil efforts to improve vitamin D nutrition among our most vulnerable and vitamin D–deficient population. John J. Cannell The Vitamin D Council and consults for DiaSorin Corporation Atascadero State Hospital, CA, USA E-mail address: jcannell@ash.dmh.ca.gov