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Zhang Q, Shen S, Guan H, Zhang J, Chen X. Orthostatic hypotension is associated with malnutrition diagnosed by GLIM in elderly hypertensive patients. BMC Geriatr 2022; 22:866. [PMID: 36384431 PMCID: PMC9670410 DOI: 10.1186/s12877-022-03546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Orthostatic Hypotension (OH) and malnutrition, are common health problems in elderly hypertensive patients. This study aimed to analyze the relationship between malnutrition and OH in elderly hypertensive patients. Methods This is a cross-sectional single-center study. All participants underwent a Comprehensive Geriatric Assessment (CGA), in which malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria based on four different methods of diagnosing muscle mass loss. Furthermore, the accuracy of these methods was verified by Receiver Operating Characteristic (ROC) analysis. Univariate and multivariate logistic regression analyses were used to identify risk factors for OH in elderly hypertensive patients. Results For GLIM criteria, when Fat-Free Mass Index (FFMI) was the gold standard for muscle mass loss, the Area Under ROC Curve (AUC) values for Upper Arm Circumference (UAC), Calf Circumference (CC), and Hand Grip Strength (HGS) were 0.784, 0.805, and 0.832, with moderate accuracy in diagnosing malnutrition. Multivariate analysis showed that females, Diabetes Mellitus (DM), diuretics, and malnutrition diagnosed by GLIM-UAC were risk factors for OH in elderly hypertensive patients. Conclusion Prompt detection of malnutrition in the elderly and attention to changes in UAC may be critical. Similarly, we should strengthen medication and disease management in elderly hypertensive patients.
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Zuin M, Brombo G, Capatti E, Romagnoli T, Zuliani G. Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis. Aging Clin Exp Res 2021; 34:951-958. [PMID: 34628636 DOI: 10.1007/s40520-021-01994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Over the latest years different studies have investigated the possible relationship between D deficiency and occurrence of orthostatic hypotension (OH), often reaching controversial results. We perform an update meta-analysis providing an update overview on the association between hypovitaminosis D and orthostatic hypotension (OH) in older adults. METHODS Data extraction was independently performed by two authors and based upon predefined criteria. The meta-analysis was performed using a random-effects model. Statistical heterogeneity between groups was measured using the Higgins I2 statistic. RESULTS Eight investigations enrolling 16.326 patients (mean age 75.5 years) met the inclusion criteria and were considered for the analysis. Patients with vitamin D deficiency were more likely to have OH compared to those without (OR: 1.36, 95% CI 1.14-1.63, p = 0.0001, I2 = 43.6%). A further sub-analysis, based on three studies, estimating the risk of OH in patients with hypovitaminosis D receiving antihypertensive treatment, did not reach the statistical significance (OR: 1.40, 95% CI 0.61-3.18, p = 0.418, I2 = 53.3%). Meta-regression performed using age (p = 0.12), BMI (p = 0.73) and gender (p = 0.62) as moderators did not reveal any statistical significance in influencing OH. Conversely, physical activity, Vitamin D supplementation and use of radioimmunoassay for the measurement of vitamin D serum levels showed a significant inverse relationship towards the risk of OH (Coeff.-0.09, p = 0.002, Coeff. - 0.12, p < 0.001 and Coeff. - 0.08, p = 0.03, respectively) among patients with hypovitaminosis D. A direct correlation between the administration of antihypertensive treatment and the risk of OH in older patients with low vitamin D level was observed (Coeff. 0.05, p < 0.001). CONCLUSIONS Hypovitaminosis D is significantly associated with OH in older adults and directly influence by the administration of antihypertensive drugs. Conversely, physical activity, vitamin D supplementation and use of radioimmunoassay as analytic method inversely correlated with the risk of OH in older patients.
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Izzo M, Carrizzo A, Izzo C, Cappello E, Cecere D, Ciccarelli M, Iannece P, Damato A, Vecchione C, Pompeo F. Vitamin D: Not Just Bone Metabolism but a Key Player in Cardiovascular Diseases. Life (Basel) 2021; 11:life11050452. [PMID: 34070202 PMCID: PMC8158519 DOI: 10.3390/life11050452] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022] Open
Abstract
Vitamin D is the first item of drug expenditure for the treatment of osteoporosis. Its deficiency is a condition that affects not only older individuals but also young people. Recently, the scientific community has focused its attention on the possible role of vitamin D in the development of several chronic diseases such as cardiovascular and metabolic diseases. This review aims to highlight the possible role of vitamin D in cardiovascular and metabolic diseases. In particular, here we examine (1) the role of vitamin D in diabetes mellitus, metabolic syndrome, and obesity, and its influence on insulin secretion; (2) its role in atherosclerosis, in which chronic vitamin D deficiency, lower than 20 ng/mL (50 nmol/L), has emerged among the new risk factors; (3) the role of vitamin D in essential hypertension, in which low plasma levels of vitamin D have been associated with both an increase in the prevalence of hypertension and diastolic hypertension; (4) the role of vitamin D in peripheral arteriopathies and aneurysmal pathology, reporting that patients with peripheral artery diseases had lower vitamin D values than non-suffering PAD controls; (5) the genetic and epigenetic role of vitamin D, highlighting its transcriptional regulation capacity; and (6) the role of vitamin D in cardiac remodeling and disease. Despite the many observational studies and meta-analyses supporting the critical role of vitamin D in cardiovascular physiopathology, clinical trials designed to evaluate the specific role of vitamin D in cardiovascular disease are scarce. The characterization of the importance of vitamin D as a marker of pathology should represent a future research challenge.
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Affiliation(s)
- Marcello Izzo
- Department of Mathematics for Technology, Medicine and Biosciences Research Center, University of Ferrara, 44121 Ferrara, Italy
- Specialist Medical Center-Via Cimitile, 80035 Nola, Italy
- Correspondence:
| | - Albino Carrizzo
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Enrico Cappello
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Domenico Cecere
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Patrizia Iannece
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Antonio Damato
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
| | - Carmine Vecchione
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (C.I.); (M.C.); (P.I.)
| | - Francesco Pompeo
- IRCCS Neuromed, 86077 Pozzilli, Italy; (A.C.); (E.C.); (D.C.); (A.D.); (C.V.); (F.P.)
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Gilani A, Ramsay SE, Welsh P, Papacosta O, Lennon LT, Whincup PH, Wannamethee SG. Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age Ageing 2021; 50:198-204. [PMID: 32902636 PMCID: PMC7793603 DOI: 10.1093/ageing/afaa146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 01/27/2023] Open
Abstract
Background orthostatic hypotension (OH) that occurs within, or at, 1 minute of standing is associated with higher risk of falls, myocardial infarction, syncope and mortality, compared to OH that occurs after 1 minute of standing. Whether vitamin D deficiency increases the risk of OH is controversial. Methods this was a cross-sectional analysis of 3,620 older, community-dwelling men. Multinomial, multiple logistic regression models were used to calculate the risk of OH across categories of vitamin D status (deficient [<25 nmol/l], insufficient [≥25–<50 nmol/l] and sufficient [≥50 nmol/l]) and parathyroid hormone quintile. Results men with vitamin D deficiency were more likely to have OH that occurred within 1 minute of standing in univariate logistic regression (OR 1.88, 95% CI 1.40–2.53) and multinomial, multiple logistic regression (OR 1.51, 95% CI 1.06–2.15), compared to men with sufficient levels of vitamin D. Vitamin D insufficiency was not associated with the risk of OH. Elevated parathyroid hormone was not associated with risk of OH. Conclusion the absence of an association between vitamin D insufficiency and risk of OH and the presence of an association between vitamin D deficiency and risk of OH suggest that there may be a threshold effect; it is only below a particular level of vitamin D that risk of OH is increased. In this cohort, the threshold was <25 nmol/l. Future work should investigate whether treating vitamin D deficiency can improve postural blood pressure or if preventing vitamin D deficiency reduces the incidence of OH.
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Affiliation(s)
- Artaza Gilani
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
- Address correspondence to: Dr Artaza Gilani. Tel: 02080168021.
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow G12 8TA, UK
| | - Olia Papacosta
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
| | - Lucy T Lennon
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - S Goya Wannamethee
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, London NW3 2PF, UK
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Fullard ME, Duda JE. A Review of the Relationship Between Vitamin D and Parkinson Disease Symptoms. Front Neurol 2020; 11:454. [PMID: 32536905 PMCID: PMC7267215 DOI: 10.3389/fneur.2020.00454] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
Vitamin D is a fat-soluble secosteroid that exerts its effects by binding to the vitamin D receptor (VDR), through which it directly and indirectly modulates the expression of hundreds to thousands of genes. While originally known for its role in regulating calcium homeostasis and metabolism, vitamin D is now associated with many other health conditions, including Parkinson's disease (PD). A high prevalence of vitamin D deficiency has been noted in PD for at least the past two decades. These findings, along with the discovery that the VDR and 1α-hydroxylase, the enzyme that converts vitamin D to its active form, are highly expressed in the substantia nigra, led to the hypothesis that inadequate levels of circulating vitamin D may lead to dysfunction or cell death within the substantia nigra. Studies investigating the relationship between vitamin D status and PD, however, have been inconsistent. Two prospective studies examined the association between mid-life vitamin D levels and risk of PD and produced conflicting results-one demonstrated an increased risk for PD with lower mid-life vitamin D levels, and the other showed no association between vitamin D and PD risk. One of the most consistent findings in the literature is the inverse association between serum vitamin D level and motor symptom severity in cross-sectional studies. While these data suggest that vitamin D may modify the disease, another likely explanation is confounding due to limited mobility. Fall risk has been associated with vitamin D in PD, but more study is needed to determine if supplementation decreases falls, which has been demonstrated in the general population. The association between vitamin D and non-motor symptoms is less clear. There is some evidence that vitamin D is associated with verbal fluency and verbal memory in PD. Studies in PD have also shown associations between vitamin D status and mood, orthostatic hypotension and olfactory impairment in PD. While more research is needed, given the numerous potential benefits and limited risks, vitamin D level assessment in PD patients and supplementation for those with deficiency and insufficiency seems justified.
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Affiliation(s)
| | - John E. Duda
- Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
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Impact of vitamin D on mobilization, pulmonary function tests, grip strength and functionality in patients with spinal cord injury: A cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.689130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laird EJ, McNicholas T, O'Halloran AM, Healy M, Molloy AM, Carey D, O'Connor D, McCarroll K, Kenny RA. Vitamin D Status Is Not Associated With Orthostatic Hypotension in Older Adults. Hypertension 2019; 74:639-644. [PMID: 31327261 DOI: 10.1161/hypertensionaha.119.13064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
There has been much interest in investigating vitamin D status with orthostatic hypotension. However, studies have been small, inconsistent, and with a lack of standardization. The aim of this study was to investigate the association with vitamin D status in a large, nationally representative older adult population using a traceable standard of measurement and an accurate assessment of beat-to-beat blood pressure (BP). This study used participants aged >50 years from The Irish Longitudinal Study on Ageing. Impaired stabilization of BP on standing was defined as a sustained drop of ≥20 mm Hg systolic BP or ≥10 mm Hg diastolic BP up to 40 seconds post stand (impaired stabilization of BP on standing). We also analyzed participants who sustained a drop of ≥20 mm Hg systolic BP or ≥10 mm Hg diastolic BP throughout the 110 seconds stand (OH110). Vitamin D was categorized into sufficient (≥50 nmol/L), insufficient (30-50 nmol/L), and deficient (<30 nmol/L) status. After exclusion criteria 4209 participants were included. Those with deficiency were more likely to be smokers, take antihypertensive medications and had higher levels of cardiovascular disorders compared with those with sufficient status. In a univariate logistic regression those with deficient (odds ratio, 1.18; 95% CI, 0.86-1.61; P=0.303) or insufficient (odds ratio, 1.13; 95% CI, 0.91; P=0.272) status were no more likely to have evidence of impaired stabilization of BP on standing on active stand compared with sufficiency. Similar findings were found for OH110: deficient (odds ratio, 0.85; 95% CI, 0.52-1.40; P=0.528) or insufficient (odds ratio, 0.86; 95% CI, 0.61-1.21; P=0.384) versus sufficiency. In conclusion, vitamin D is not significantly associated with orthostatic hypotension in older adults.
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Affiliation(s)
- Eamon J Laird
- From the Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin, Ireland (E.J.L., T.M., A.M.O., D.C., C.O., R.A.K.)
| | - Triona McNicholas
- From the Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin, Ireland (E.J.L., T.M., A.M.O., D.C., C.O., R.A.K.)
| | - Aisling M O'Halloran
- From the Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin, Ireland (E.J.L., T.M., A.M.O., D.C., C.O., R.A.K.)
| | - Martin Healy
- Department of Biochemistry, St James's Hospital, Dublin, Ireland (M.H.)
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Ireland (A.M.M.)
| | - Daniel Carey
- From the Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin, Ireland (E.J.L., T.M., A.M.O., D.C., C.O., R.A.K.)
| | - Deirdre O'Connor
- From the Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin, Ireland (E.J.L., T.M., A.M.O., D.C., C.O., R.A.K.)
| | - Kevin McCarroll
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland (K.M., R.A.K.)
| | - Rose Anne Kenny
- From the Department of Medical Gerontology, The Irish Longitudinal Study on Ageing (TILDA), Lincoln Gate, Trinity College, Dublin, Ireland (E.J.L., T.M., A.M.O., D.C., C.O., R.A.K.).,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland (K.M., R.A.K.)
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Hebson CL, McConnell ME, Hannon DW. Pediatric dysautonomia: Much‐maligned, often overmedicated, but not as complex as you think. CONGENIT HEART DIS 2018; 14:156-161. [DOI: 10.1111/chd.12720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Camden L. Hebson
- Division of Pediatric Cardiology, Department of Pediatrics University of Alabama School of Medicine Birmingham Alabama
| | - Michael E. McConnell
- Division of Pediatric Cardiology, Department of Pediatrics Emory University School of Medicine Atlanta Georgia
| | - David W. Hannon
- Division of Pediatric Cardiology, Department of Pediatrics East Carolina University Brody School of Medicine Greenville North Carolina
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Kocyigit SE, Soysal P, Ates Bulut E, Isik AT. Malnutrition and Malnutrition Risk Can Be Associated with Systolic Orthostatic Hypotension in Older Adults. J Nutr Health Aging 2018; 22:928-933. [PMID: 30272095 DOI: 10.1007/s12603-018-1032-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Malnutrition and orthostatic hypotension(OH) are the two important geriatric syndromes, which have similar negative outcomes such as falls. The aim of the study is to detect whether there is any relation between malnutrition and OH. METHODS 862 geriatric patients, who had undergone comprehensive geriatric assessment (CGA),were included in the retrospective study. OH was identified as 20 and/or 10 mmHg dropped for systolic and/or diastolic blood pressures with the active standing test when patients got up from supine to standing position. Nutritional status was checked according to Mini Nutritional Assesment-Short Form(MNA-SF). RESULTS The mean age of the patients was 74±8.05, and %66.3 of them were female. The prevalence of malnutrition, malnutrition-risk and OH were detected as 7.7%, 26.9 % and 21.2%, respectively. When OH, systolic OH, diastolic OH and control group were compared with CGA parameters and the effects of age and gender were removed, the frequency of falls and Timed-Up and Go Test were higher, activity daily living indexes and TINETTI-Balance scores were lower in systolic OH than without it (p<0.05).Systolic OH was more frequent in malnutrition-risk and malnutrition group than control group (p<0.002 and p<0.05, respectively). Diastolic OH was not associated with nutritional status (p>0.05).OH was only higher in malnutrition-risk group than robust (p<0.05). CONCLUSION Our findings suggest that not only malnutrition but also malnutrition-risk may be associated with systolic OH, which leads to many negative outcomes in older adults. Because malnutrition/ malnutrition risk is preventable and reversible, nutritional status should be checked during the evaluation of OH patients.
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Affiliation(s)
- S E Kocyigit
- A.T. Isik, Center for Aging Brain and Dementia, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey,
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Luukkonen A, Tiihonen M, Rissanen T, Hartikainen S, Nykänen I. Orthostatic Hypotension and Associated Factors among Home Care Clients Aged 75 Years or Older - A Population-Based Study. J Nutr Health Aging 2018; 22:154-158. [PMID: 29300435 DOI: 10.1007/s12603-017-0953-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older. DESIGN Non-randomised controlled study. SETTING AND PARTICIPANTS The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland. MEASUREMENTS Nurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records. RESULTS The prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014-1.283) appeared to be independently connected to a risk of OH. CONCLUSION One-third of the home clients had OH and it was associated with lower MNA scores.
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Affiliation(s)
- A Luukkonen
- Miia Tiihonen, Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio Campus, P.O.BOX 1627, FI-70211 Kuopio, Finland, Phone +358 40 355 3125, Fax: 358 17 162 131, E-mail:
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Christou GA, Kiortsis DN. The effects of body weight status on orthostatic intolerance and predisposition to noncardiac syncope. Obes Rev 2017; 18:370-379. [PMID: 28112481 DOI: 10.1111/obr.12501] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 12/16/2022]
Abstract
Orthostatic intolerance (OI) is frequently the mechanism underlying the occurrence of noncardiac syncope (NCS) and is associated with substantial risk for injury. Body weight status appears to be a modifier of orthostatic responses and possibly influences the propensity to NCS. The majority of cross-sectional studies have found that the lower the body mass index (BMI) the greater the predisposition to OI is, accompanied with both down-regulation of sympathetic nervous system activity and up-regulation of parasympathetic nervous system activity. These changes appear to occur across the whole spectrum of BMI values from underweight to obesity, while they may be associated more strongly with central body fat than total body fat. Weight loss following bariatric surgery has been consistently found to increase OI, attributed first to the effects of weight loss per se, second to the specific type of surgical procedure and third to the potential postoperative autonomic neuropathy due to vitamin deficiency. The increased OI following bariatric surgery renders this intervention not easily tolerable for the affected individuals, mandating increased fluid and salt intake, pharmacological measures or surgical adjustments to attenuate OI. All future studies investigating orthostatic responses and NCS should implement a matching of the population arms for BMI and ideally for body fat.
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Affiliation(s)
- G A Christou
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - D N Kiortsis
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
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Veronese N, Trevisan C, Bolzetta F, De Rui M, Zambon S, Musacchio E, Sartori L, Stubbs B, Perissinotto E, Crepaldi G, Manzato E, Sergi G. Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults. ACTA ACUST UNITED AC 2016; 10:724-32. [PMID: 27492009 DOI: 10.1016/j.jash.2016.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/05/2016] [Accepted: 06/21/2016] [Indexed: 01/21/2023]
Abstract
A number of small cross sectional studies have demonstrated that hypovitaminosis D (represented by low 25 hydroxyvitamin D (25OHD) levels) is associated with orthostatic hypotension (OH). We investigated if hypovitaminosis D is associated with the onset of OH in older adults over a follow-up of 4.4 years. 25OHD was categorized using sex-specific quartiles; OH was defined as a drop of ≤20 mm Hg in systolic or ≤10 mm Hg in diastolic blood pressure <3 minutes of standing. Among 1308 elderly without OH at baseline, using an adjusted logistic regression analysis and taking those with higher baseline serum 25OHD as reference, there was a significant increase in the onset of OH in those with lower serum 25OHD levels. The association was significant only in women when we stratified by sex. In conclusion, hypovitaminosis D predicts the onset of OH in older adults, particularly in women.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.
| | - Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Francesco Bolzetta
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Marina De Rui
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Sabina Zambon
- National Research Council, Neuroscience Institute, Padova, Italy; Department of Medicine DIMED, Clinica Medica I, University of Padova, Padova, Italy
| | - Estella Musacchio
- Department of Medicine DIMED, Clinica Medica I, University of Padova, Padova, Italy
| | - Leonardo Sartori
- Department of Medicine DIMED, Clinica Medica I, University of Padova, Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Egle Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy
| | - Gaetano Crepaldi
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
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Ometto F, Stubbs B, Annweiler C, Duval GT, Jang W, Kim HT, McCarroll K, Cunningham C, Soysal P, Isik AT, Luchini C, Solmi M, Sergi G, Manzato E, Veronese N. Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. J Hypertens 2016; 34:1036-43. [PMID: 27027426 DOI: 10.1097/hjh.0000000000000907] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes. Recently, interest has developed in hypovitaminosis D (defined as low 25 hydroxiyvitamin D levels) as a potential risk factor for orthostatic hypotension. We conducted a systematic review and meta-analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D, including the adjustment of potential confounders (age, sex, BMI, renal function, comorbidities, seasonality, use of antihypertensive medications, and supplementation with cholecalciferol). METHODS A systematic literature search of major electronic databases from inception until 09/2015 was made for articles providing data on orthostatic hypotension and hypovitaminosis D. A random effects meta-analysis of cross-sectional studies investigating orthostatic hypotension prevalence comparing participants with vs. those without hypovitaminosis D was undertaken, calculating the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Of 317 initial hits, five cross-sectional studies were meta-analysed including 3646 participants (1270 with hypovitaminosis D and 2376 without). The participants with hypovitaminosis D had a higher prevalence of orthostatic hypotension (OR = 1.88; 95% CI: 1.25-2.84; I = 68%) that was not affected by adjusting for a median of five potential confounders (OR = 2.03; 95% CI: 1.13-3.68; I = 73%). People with orthostatic hypotension had significantly reduced serum vitamin D concentrations (standardized mean difference = -0.42; 95% CI: -0.72 to -0.12). One longitudinal study confirmed the association between hypovitaminosis D and orthostatic hypotension. CONCLUSION Our meta-analysis highlights that hypovitaminosis D is associated with orthostatic hypotension, independent of potential confounders. Further longitudinal studies and clinical trials are required to confirm these findings.
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Affiliation(s)
- Francesca Ometto
- aRheumatology Unit, Department of Medicine University of Padova, Padova, Italy bPhysiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill cHealth Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London dDepartment of Neuroscience and Memory Clinic, Division of Geriatric Medicine, Angers University Hospital; UPRES EA 4638, University of Angers, Angers, France eRobarts Research Institute, University of Western Ontario, London, Ontario, Canada fDepartment of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung gDepartment of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea hDepartment of Gerontology, St James's Hospital, Dublin, Ireland Mercers Institute for Research on Ageing, Dublin, Ireland iDepartment of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey jDepartment of Pathology and Diagnostics, Verona University and Hospital Trust, Verona kDepartment of Pathology, Santa Chiara Hospital, Trento lDepartment of Neurosciences, Local Health Unit 17, Mental Health Department, Monselice mDepartment of Medicine, Geriatrics Section, University of Padova nInstitute of Clinical Research and Education in Medicine (IREM), Padova, Italy *Francesca Ometto and Brendon Stubbs equally contributed to the writing of this article
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Guérin A, Bureau ML, Ghazali N, Gervais R, Liuu E, Seité F, Bellarbre F, Ingrand P, Paccalin M. Factors associated with orthostatic hypotension in hospitalized elderly patients. Aging Clin Exp Res 2016; 28:513-7. [PMID: 26482745 DOI: 10.1007/s40520-015-0451-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/09/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the factors associated with orthostatic hypotension (OH) in hospitalized elderly patients. DESIGN Prospective observational single center study. SETTING A French academic center. PARTICIPANTS One hundred and thirty-one patients without OH symptoms who underwent OH testing. MEASUREMENTS The OH test was performed when the patient was able to get out of the bed and was no longer receiving parenteral fluids. The blood pressure was measured after a 10-min rest while the patients were sitting and then standing at 1 and 3 min. Demographic data, co-morbidities, current medications and biological parameters were recorded. RESULTS The mean patient age was 84.3 ± 7 years. The mean CIRS-G score was 10.6 ± 3.8. The OH test was performed 6.3 ± 3.9 days after admission and was positive in 39 (29.8 %) patients (95 % confidence interval (CI) 22, 38) and positive at 1 min in 87.2 % of the cases. Multivariate analysis showed that OH prevalence correlated with diabetes (odds ratio (OR) = 4.23; 95 % CI 1.10, 16.24; P = 0.03), serum 25-hydroxyvitamin D <20 ng/ml (OR = 3.38; 95 % CI 1.36, 8.42; P = 0.008), use of tranquilizers (anxiolytic and hypnotic) (OR = 2.96; 95 % CI 1.18, 7.4; P = 0.02), CIRS-G score (OR = 1.15; 95 % CI 1.01, 1.31; P = 0.03) and lack of diuretics (OR = 0.20; 95 % CI 0.06, 0.63; P = 0.005). CONCLUSION In older adults, OH is often misdiagnosed because it is asymptomatic. As practitioners may be reluctant to perform the OH test because of time constraints, targeting a subgroup of patients with a higher risk of OH should be worthwhile to prevent further OH complications.
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Affiliation(s)
- Aline Guérin
- Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France
| | | | - Nisrin Ghazali
- Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France
| | | | - Evelyne Liuu
- Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France
| | - Florent Seité
- Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France
| | | | - Pierre Ingrand
- Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
- INSERM, CIC-P 1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France.
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Jang W, Park J, Kim JS, Youn J, Oh E, Kwon KY, Jo KD, Lee MK, Kim HT. Vitamin D deficiency in Parkinson's disease patients with orthostatic hypotension. Acta Neurol Scand 2015; 132:242-50. [PMID: 25708272 DOI: 10.1111/ane.12390] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The purpose of our study was to investigate the associations between serum vitamin D3 levels and orthostatic hypotension (OH) in patients with Parkinson's disease (PD). MATERIALS AND METHODS Fifty-five patients with PD were enrolled in this study. Blood pressure (BP) measurements were gathered while the patients were in the supine position and while standing up. Then, the patients were divided into two groups: PD patients with and without OH. We compared the levels of serum 25-hydroxyvitamin D3 and 1, 25-dihydroxyvitamin D3 (calcitriol) between the two groups. RESULTS Serum 25-hydroxyvitamin D and calcitriol levels were significantly decreased in patients with OH compared with those without OH. The systolic and diastolic BPs and symptom severities significantly negatively correlated with the serum 25-hydroxyvitamin D and calcitriol levels. CONCLUSIONS Although the underlying mechanism for this association is not fully understood, our results suggest that low vitamin D status is associated with OH in patients with PD.
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Affiliation(s)
- W. Jang
- Department of Neurology; Gangneung Asan Hospital; University of Ulsan College of Medicine; Gangneung Korea
| | - J. Park
- Department of Neurology; Haeundae Paik Hospital; Inje University; Busan Korea
| | - J. S. Kim
- Department of Neurology; Soonchunhyang University College of Medicine; Seoul Korea
| | - J. Youn
- Department of Neurology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - E. Oh
- Department of Neurology; Chungnam National University Hospital; College of Medicine; Daejeon Korea
| | - K. Y. Kwon
- Department of Family Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - K. D. Jo
- Department of Neurology; Gangneung Asan Hospital; University of Ulsan College of Medicine; Gangneung Korea
| | - M. K. Lee
- Department of Neurology; Gangneung Asan Hospital; University of Ulsan College of Medicine; Gangneung Korea
| | - H.-T. Kim
- Department of Neurology; Hanyang University College of Medicine; Seoul Korea
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Duval GT, Brangier A, Barré J, Launay CP, Beauchet O, Annweiler C. Vitamin D Deficiency and Incident Onset of Orthostatic Hypotension in Older Adults: Preliminary Results from the 'MERE' Study. J Am Geriatr Soc 2015; 63:1245-7. [PMID: 26096400 DOI: 10.1111/jgs.13504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Guillaume T Duval
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Center, Angers University Hospital, Angers, France
| | - Antoine Brangier
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Center, Angers University Hospital, Angers, France
| | - Jean Barré
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Center, Angers University Hospital, Angers, France
| | - Cyrille P Launay
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Center, Angers University Hospital, Angers, France
| | - Olivier Beauchet
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Center, Angers University Hospital, Angers, France.,UPRES EA 4638, University of Angers, UNAM, Angers, France
| | - Cedric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Center, Angers University Hospital, Angers, France.,UPRES EA 4638, University of Angers, UNAM, Angers, France.,Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Shen S, He T, Chu J, He J, Chen X. Uncontrolled hypertension and orthostatic hypotension in relation to standing balance in elderly hypertensive patients. Clin Interv Aging 2015; 10:897-906. [PMID: 26064042 PMCID: PMC4455870 DOI: 10.2147/cia.s81283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the associations among uncontrolled hypertension, orthostatic hypotension (OH), and standing balance impairment in the elderly hypertensive patients referred to comprehensive geriatric assessment (CGA). Methods In a cross-sectional study, a total of 176 elderly hypertensive patients who underwent CGA were divided into OH group (n=36) and non-OH group (n=140) according to blood pressure measurement in the supine position, after immediate standing up, and after 1 minute and 3 minutes of standing position. Uncontrolled hypertension was defined as blood pressure of ≥140/90 mmHg if accompanied by diabetes mellitus (DM) or chronic kidney disease (CKD), or ≥150/90 mmHg if no DM and no CKD. Standing balance, including immediate standing balance and prolonged standing balance, was assessed in side-by-side and tandem stance. Results Neither uncontrolled hypertension nor OH was associated with prolonged standing balance impairment in elderly hypertensive patients (P>0.05). Blood pressure decrease after postural change was significantly associated with immediate standing balance impairment in side-by-side and tandem stance (P<0.05). Patients with OH were at greater risk of immediate standing balance impairment in both side-by-side and tandem stance than those without OH (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.26–9.33, P<0.05; OR 3.14, 95% CI 1.14–8.64, P<0.01). Furthermore, uncontrolled hypertension was associated with immediate standing balance impairment in side-by-side stance (OR 2.96, 95% CI 1.31–6.68, P<0.05). Conclusion Uncontrolled hypertension, OH, and blood pressure decrease after postural change were associated with immediate standing balance impairment, and therefore, a better understanding of the underlying associations might have major clinical value.
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Affiliation(s)
- Shanshan Shen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Ting He
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Jiaojiao Chu
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Jin He
- Department of Neurology, Fuyuan Hospital of Yiwu, Jinhua, People's Republic of China
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China
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Links between Vitamin D Deficiency and Cardiovascular Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:109275. [PMID: 26000280 PMCID: PMC4427096 DOI: 10.1155/2015/109275] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
Abstract
The aim of the present paper was to review the most important mechanisms explaining the possible association of vitamin D deficiency and cardiovascular diseases, focusing on recent experimental and clinical data. Low vitamin D levels favor atherosclerosis enabling vascular inflammation, endothelial dysfunction, formation of foam cells, and proliferation of smooth muscle cells. The antihypertensive properties of vitamin D include suppression of the renin-angiotensin-aldosterone system, renoprotective effects, direct effects on endothelial cells and calcium metabolism, inhibition of growth of vascular smooth muscle cells, prevention of secondary hyperparathyroidism, and beneficial effects on cardiovascular risk factors. Vitamin D is also involved in glycemic control, lipid metabolism, insulin secretion, and sensitivity, explaining the association between vitamin D deficiency and metabolic syndrome. Vitamin D deficit was associated in some studies with the number of affected coronary arteries, postinfarction complications, inflammatory cytokines and cardiac remodeling in patients with myocardial infarction, direct electromechanical effects and inflammation in atrial fibrillation, and neuroprotective effects in stroke. In peripheral arterial disease, vitamin D status was related to the decline of the functional performance, severity, atherosclerosis and inflammatory markers, arterial stiffness, vascular calcifications, and arterial aging. Vitamin D supplementation should further consider additional factors, such as phosphates, parathormone, renin, and fibroblast growth factor 23 levels.
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Thiamine and magnesium deficiencies: keys to disease. Med Hypotheses 2014; 84:129-34. [PMID: 25542071 DOI: 10.1016/j.mehy.2014.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
Thiamine deficiency (TD) is accepted as the cause of beriberi because of its action in the metabolism of simple carbohydrates, mainly as the rate limiting cofactor for the dehydrogenases of pyruvate and alpha-ketoglutarate, both being critical to the action of the citric acid cycle. Transketolase, dependent on thiamine and magnesium, occurs twice in the oxidative pentose pathway, important in production of reducing equivalents. Thiamine is also a cofactor in the dehydrogenase complex in the degradation of the branched chain amino acids, leucine, isoleucine and valine. In spite of these well accepted facts, the overall clinical effects of TD are still poorly understood. Because of the discovery of 2-hydroxyacyl-CoA lyase (HACL1) as the first peroxisomal enzyme in mammals found to be dependent on thiamine pyrophosphate (TPP) and the ability of thiamine to bind with prion protein, these factors should improve our clinical approach to TD. HACL1 has two important roles in alpha oxidation, the degradation of phytanic acid and shortening of 2-hydroxy long-chain fatty acids so that they can be degraded further by beta oxidation. The downstream effects of a lack of efficiency in this enzyme would be expected to be critical in normal brain metabolism. Although TD has been shown experimentally to produce reversible damage to mitochondria and there are many other causes of mitochondrial dysfunction, finding TD as the potential biochemical lesion would help in differential diagnosis. Stresses imposed by infection, head injury or inoculation can initiate intermittent cerebellar ataxia in thiamine deficiency/dependency. Medication or vaccine reactions appear to be more easily initiated in the more intelligent individuals when asymptomatic marginal malnutrition exists. Erythrocyte transketolase testing has shown that thiamine deficiency is widespread. It is hypothesized that the massive consumption of empty calories, particularly those derived from carbohydrate and fat, results in a high calorie/thiamine ratio as a major cause of disease. Because mild to moderate TD results in pseudo hypoxia in the limbic system and brainstem, emotional and stress reflexes of the autonomic nervous system are stimulated and exaggerated, producing symptoms often diagnosed as psychosomatic disease. If the biochemical lesion is recognized at this stage, the symptoms are easily reversible. If not, and the malnutrition continues, neurodegeneration follows and results in a variety of chronic brain diseases. Results from acceptance of the hypothesis could be tested by performing erythrocyte transketolase tests to pick out those with TD and supplementing the affected individuals with the appropriate dietary supplements.
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Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Vitamin D insufficiency in the elderly orthopaedic patient: an epidemic phenomenon. INTERNATIONAL ORTHOPAEDICS 2014; 39:787-92. [PMID: 25205247 DOI: 10.1007/s00264-014-2519-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this observational study was to evaluate serum levels of 25-OH-D of elderly patients presenting with orthopaedic illness. Furthermore, we enquired about potential confounders and risk factors of hypovitaminosis D in comorbidities and daily medication of the elderly. METHODS Vitamin D levels in 1,083 patients aged >70 years and admitted to an orthopaedic surgery department were measured. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels. RESULTS Overall, 86 % of patients had insufficient serum levels of 25-OH-D and >60 % were vitamin D deficient. Serum vitamin D levels were lower during winter and months with fewer sunshine hours. Patients presenting with obesity, hypertension and osteoporosis were more likely to have low vitamin D levels. CONCLUSIONS We found a high prevalence of hypovitaminosis D in elderly, nonhospitalized orthopaedic patients. Given the well-known effects of vitamin D on bone metabolism and muscle health, as well as its nonskeletal effects, vitamin D insufficiency may have a negative impact.
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Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Intern Med 2014; 276:285-95. [PMID: 24444004 DOI: 10.1111/joim.12201] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Orthostatic hypotension, a condition that mostly affects 'oldest-old' (i.e. ≥80 years) adults, is primarily explained by age-related dysfunction of blood pressure control. Vitamin D may contribute to blood pressure control. The aim of this study was to determine whether vitamin D deficiency is associated with orthostatic hypotension in oldest-old adults. DESIGN Cross-sectional analysis at baseline of the EPIDOS study. SETTING Five French areas. PARTICIPANTS A total of 329 community-dwelling oldest-old women (mean age 83.3 ± 0.2 years). MAIN OUTCOMES MEASURES Orthostatic hypotension was defined as a systolic blood pressure drop of ≥20 mmHg and/or a diastolic blood pressure drop of ≥10 mmHg within 3 min of standing. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25OHD) concentration ≤10 ng mL(-1) . Covariates included in the models were age, body mass index, diabetes mellitus, supine mean arterial pressure, number of drugs taken per day, use of antihypertensive or psychoactive drugs, cognition, quadriceps strength, current smoking, alcohol consumption, serum concentrations of parathyroid hormone, calcium and creatinine and season of testing. RESULTS Diastolic orthostatic hypotension was observed more often among women with vitamin D deficiency (19.2%) compared to those without (10.0%; P = 0.03). There was an inverse linear association between 25OHD concentration and change in diastolic blood pressure after 3 min of standing (adjusted β = -0.07, P = 0.046). Similarly, 25OHD deficiency was associated with orthostatic hypotension [adjusted odds ratio (OR) 3.36, P = 0.004], specifically with diastolic orthostatic hypotension (adjusted OR 3.81, P = 0.003). CONCLUSIONS 25OHD deficiency was associated with orthostatic hypotension in oldest-old women, due to a greater drop in diastolic blood pressure on standing. This finding may lead to better understanding of the pathophysiology of falls in oldest-old adults with vitamin D deficiency.
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Affiliation(s)
- C Annweiler
- Department of Geriatric Medicine, Angers University Hospital, Angers, France; UPRES EA4638, University of Angers, UNAM, Angers, France; Robarts Research Institute, The University of Western Ontario, London, ON, Canada
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Veronese N, Bolzetta F, De Rui M, Zambon S, Corti MC, Musacchio E, Baggio G, Crepaldi G, Perissinotto E, Manzato E, Sergi G. Serum 25-Hydroxyvitamin D and Orthostatic Hypotension in Old People. Hypertension 2014; 64:481-6. [DOI: 10.1161/hypertensionaha.114.03143] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Nicola Veronese
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Francesco Bolzetta
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Marina De Rui
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Sabina Zambon
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Maria-Chiara Corti
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Estella Musacchio
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Giovannella Baggio
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Gaetano Crepaldi
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Egle Perissinotto
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Enzo Manzato
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
| | - Giuseppe Sergi
- From the Department of Medicine, Geriatrics Division (N.V., F.B., M.D.R., E.M., G.S.), Department of Medical and Surgical Sciences (S.Z., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology, and Public Health Unit (E.P.), University of Padova, Padova, Italy; National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy (S.Z., G.C., E.M.); Azienda Unità Locale Socio Sanitaria, Padova, Italy (M.-C.C.); and Internal Medicine Division, Azienda
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Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients? Arch Gerontol Geriatr 2014; 59:74-7. [PMID: 24742775 DOI: 10.1016/j.archger.2014.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/17/2014] [Accepted: 03/22/2014] [Indexed: 12/24/2022]
Abstract
Orthostatic hypotension (OH) is closely associated with falls, cardiovascular events and mortality in the elderly patients. The aim of the study is to evaluate the OH prevalence among patients over the age of 65 years, to find out the impact of this condition on daily living activities, and to determine the possible effects of vitamin D levels on OH in elderly patients. Eight hundred and forty nine geriatric patients who had undergone comprehensive geriatric assessment were retrospectively evaluated and 546 patients were included in the study. The patient's demographic characteristics, blood pressures, comorbid diseases, polypharmacy status, cognitive and nutritional states, basic and instrumental daily living activity indexes and laboratory values were obtained from hospital files. Serum 25-hydroxyvitamin D [25(OH)D] was measured by radioimmunoassay. The prevalence of OH was found to be 27.5%. Both daily living activity indexes were significantly lower in older patients with OH (p<0.02), and serum 25(OH)D levels were significantly lower in older patients with OH (p<0.01). Our findings suggest that vitamin D deficiency may be a factor in OH development. Because this condition is also preventable and correctable, serum vitamin D levels should be checked during the evaluation of OH patients and any detected deficiency should be treated accordingly.
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Haring B, Pettinger M, Bea JW, Wactawski-Wende J, Carnahan RM, Ockene JK, Wyler von Ballmoos M, Wallace RB, Wassertheil-Smoller S. Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. BMC Geriatr 2013; 13:38. [PMID: 23635086 PMCID: PMC3645973 DOI: 10.1186/1471-2318-13-38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/22/2013] [Indexed: 12/20/2022] Open
Abstract
Background Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated. Methods This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (≥2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI. Results Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval [CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake. Conclusion These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use.
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Affiliation(s)
- Bernhard Haring
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg 97080, Germany.
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