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Q J Med 2002; 95: 15-21
© 2002 Association of Physicians

Size at birth, adult intestinal calcium absorption and 1,25(OH)2 vitamin D

N.K. Arden1,, P. Major2, J.R. Poole1, R.W. Keen2,*, S. Vaja3, R. Swaminathan3, C. Cooper1 and T.D. Spector2

From the 1 MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton, 2 Twin Research and Genetic Epidemiology Unit and 3 Department of Chemical Pathology, St Thomas's Hospital, London, UK

Received 6 June 2001 and in revised form 4 November 2001

Background: Adult bone mineral status is modified by early environmental influences, but the mechanism of this phenomenon is unknown. Intestinal calcium absorption and vitamin D metabolism are integrally involved in bone metabolism and may be programmed during early life.

Aim: To examine the early-life influences on calcium absorption and its control in 322 post-menopausal female twins.

Methods: Intestinal calcium absorption was assessed by the stable strontium (Sr) method. Serum PTH, 25(OH) and 1,25(OH)2 vitamin D were measured and recalled birth weight recorded.

Results: Fractional intestinal Sr absorption ({alpha}Sr) was correlated with serum 1,25(OH)2 vitamin D (p<0.001), but not with 25(OH) vitamin D. Birth weight was inversely associated with serum 1,25(OH)2 vitamin D (p=0.04), the association being independent of serum calcium, phosphate, creatinine and PTH. Birth weight was inversely correlated with {alpha}Sr (p=0.03), this association being independent of age, season, customary calcium intake and serum 25(OH) vitamin D; however, when serum 1,25(OH)2 vitamin D was added into the model, the association became non-significant, suggesting that the association was partially mediated via serum 1,25(OH)2 vitamin D.

Discussion: We found a significant inverse association between birth weight and intestinal calcium absorption that is partially explained by an association between serum 1,25(OH)2 vitamin D and birth weight. This suggests a mechanism whereby the intra-uterine environment might affect adult skeletal status.

Address correspondence to Dr N.K. Arden, MRC Environmental Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD. e-mail: nka{at}mrc.soton.ac.uk

* Current address: Department of Medicine, University College London, London WC1E 6JJ.


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