Low 25-hydroxyvitamin D concentrations predict incident depression in well-functioning older adults: the health, aging, and body composition study

Does Vitamin D3 Supplementation Improve Depression Scores among Rural Adolescents? A Randomized Controlled Trial

BACKGROUND

Contemporary evidence has been established demonstrating that stunted vitamin D levels are associated with depression, poor mood, and other mental disorders. Individuals with normal vitamin D levels have a much lower probability of developing depression. Improving vitamin D levels by supplementation has shown betterment in depressive patients among different age groups. The objective of this study was to assess the effect of vitamin D supplementation on depression scores among rural adolescents.

MATERIAL AND METHODS

This study was a cluster randomized controlled trial carried out for a period of 3 years among adolescents from rural Kolar. The sample size was calculated based on previous research and was determined to be 150 for each group. The intervention arm received 2250 IU of vitamin D, and the control arm received a lower dose of 250 IU of vitamin D for 9 weeks. To assess sociodemographic status, a pretested, semi-structured questionnaire was used, and, to assess depression, the Beck Depression Inventory (BDI-II) was used. A baseline assessment was carried out for vitamin D status and depression status, followed by a post-intervention assessment. From the start of the trial, the participants were contacted every week by the pediatric team to investigate any side effects.

RESULTS

Out of 235 school students in the vitamin D supplementation arm, 129 (54.9%) belonged to the 15 years age group, 124 (52.8%) were boys, and 187 (79.6%) belonged to a nuclear family. Out of 216 school students in the calcium supplementation arm, 143 (66.2%) belonged to the 15 years age group, 116 (53.7%) were girls, and 136 (63%) belonged to a nuclear family. By comparing Beck depression scores before and after the intervention, it was found that the vitamin D intervention arm showed a statistically significant reduction in Beck depression scores.

CONCLUSIONS

The present study showed that vitamin D supplementation reduced depression scores, showing some evidence that nutritional interventions for mental health issues such as depression are an excellent option. Vitamin D supplementation in schools can have numerous beneficiary effects on health while mutually benefiting mental health.

Vitamin D serum concentration is prospectively associated with depressive symptoms in the EpiFloripa Aging Cohort Study: a structural equation modeling approach

OBJECTIVE

To evaluate the direct, indirect, and total prospective effects of serum concentrations of 25-hydroxycholecalciferol (25[OH]D) on depressive symptoms in older adults.

METHODS

Data from the second (2013-2015) and third (2017-2019) waves of the EpiFloripa Aging Cohort Study (= 60 years) were analyzed. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale. 25(OH)D levels were measured using the microparticle chemiluminescence method. A directed acyclic graph was constructed to identify the minimum set of adjustments. Structural equation modeling analysis was used to determine the effects of 25(OH)D on depressive symptoms.

RESULTS

Data from 574 older adults (63.1% female) were analyzed. In the follow-up (n=390), 16.2% of them presented severe depressive symptoms (= 6 points). Structural equation modeling analysis revealed that 25(OH)D had a small direct negative effect (ß = -0.11, p < 0.05) and an overall negative effect (ß = -0.13; p < 0.05) on depressive symptoms in wave 3 (increased 25[OH]D led to decreased depressive symptoms). No direct or indirect effect on depressive symptoms was found in wave 2.

CONCLUSION

Our findings indicate a prospective association between 25(OH)D and depressive symptoms, suggesting a long-term effect in older adults from southern Brazil.

Vitamin D and depression in older adults: lessons learned from observational and clinical studies

Depression is a mental disorder triggered by the interaction of social, psychological and biological factors that have an important impact on an individual's life. Despite being a well-studied disease with several established forms of treatment, its prevalence is increasing, especially among older adults. New forms of treatment and prevention are encouraged, and some researchers have been discussing the effects of vitamin D (VitD) on depression; however, the exact mechanism by which VitD exerts its effects is not yet conclusive. In this study, we aimed to discuss the possible mechanisms underlying the association between VitD and depression in older adults. Therefore, we conducted a systematic search of databases for indexed articles published until 30 April 2021. The primary focus was on both observational studies documenting the association between VitD and depression/depressive symptoms, and clinical trials documenting the effects of VitD supplementation on depression/depressive symptoms, especially in older adults. Based on pre-clinical, clinical and observational studies, it is suggested that the maintenance of adequate VitD concentrations is an important issue, especially in older adults, which are a risk population for both VitD deficiency and depression. Nevertheless, it is necessary to carry out more studies using longitudinal approaches in low- and middle-income countries to develop a strong source of evidence to formulate guidelines and interventions.

The Health, Aging, and Body Composition (Health ABC) Study-Ground-Breaking Science for 25 Years and Counting

BACKGROUND

The Health, Aging, and Body Composition Study is a longitudinal cohort study that started just over 25 years ago. This ground-breaking study tested specific hypotheses about the importance of weight, body composition, and weight-related health conditions for incident functional limitation in older adults.

METHODS

Narrative review with analysis of ancillary studies, career awards, publications, and citations.

RESULTS

Key findings of the study demonstrated the importance of body composition as a whole, both fat and lean mass, in the disablement pathway. The quality of the muscle in terms of its strength and its composition was found to be a critical feature in defining sarcopenia. Dietary patterns and especially protein intake, social factors, and cognition were found to be critical elements for functional limitation and disability. The study is highly cited and its assessments have been widely adopted in both observational studies and clinical trials. Its impact continues as a platform for collaboration and career development.

CONCLUSIONS

The Health ABC provides a knowledge base for the prevention of disability and promotion of mobility in older adults.

Sustaining an ageing population: the role of micronutrients in frailty and cognitive impairment

Age-related frailty and cognitive decline are complex multidimensional conditions that significantly impact the ability of older adults to sustain functional capacity and independence. While underlying causes remain poorly understood, nutrition continually emerges as one associated risk element. Many studies have addressed the importance of adequate nutrition in delaying the onset of these conditions, but the specific role of micronutrients is not well established. The consideration of pre-frailty as an outcome variable is also limited in the current literature. In this review, we focus on the potential value of maintaining micronutrient sufficiency to sustaining the health of the ageing population. Using data from the Irish longitudinal study on ageing, we consider several vitamins known to have a high prevalence of low status in older adults and their impact on pre-frailty, frailty and cognitive impairment. They include vitamin B12 and folate, both of which are associated with multiple biological mechanisms involved in long-term health, in particular in cognitive function; vitamin D, which has been associated with increased risk of musculoskeletal disorders, depression and other chronic diseases; and the carotenoids, lutein and zeaxanthin, that may help mitigate the risk of frailty and cognitive decline via their antioxidant and anti-inflammatory properties. We show that low concentrations of folate and carotenoids are implicated in poorer cognitive health and that the co-occurrence of multiple nutrient deficiencies confers greatest risk for frailty and pre-frailty in the Irish longitudinal study on ageing cohort. These health associations contribute to evidence needed to optimise micronutrient status for health in the older adult population.

Low plasma 25-hydroxyvitamin D levels are associated with an increased risk of depressive symptoms in community-dwelling Japanese people aged between 40 and 74 years: The Murakami cohort study

BACKGROUND

Association between vitamin D levels and the occurrence of depression are not always consistent. The present cohort study aimed to determine this association in older adults, using a method for measuring vitamin D levels which is more accurate than those used in previous studies.

METHODS

Participants were 3447 individuals aged 40-74 years without depressive symptoms at baseline who participated in the 5-year follow-up survey. The baseline investigation, including a self-administered questionnaire survey and blood collection, was conducted in 2011-2013. Plasma 25-hydroxyvitamin D (25[OH]D) levels were measured, and divided into overall quartiles summed up by sub-quartiles and stratified by age, sex, and season. The outcome was depressive symptoms determined by the CES-D (11-item, cut-off score of 6/7) 5 years later. Covariates were demographics, lifestyles, baseline CES-D score, and disease history.

RESULTS

Mean plasma 25(OH)D levels were 58.0 nmol/L in men and 45.7 in women (P < 0.0001), and cumulative incidences of depressive symptoms were 249/1577 (15.8 %) in men and 313/1870 (16.7 %) in women (P = 0.4526). The lower 25(OH)D quartile group had higher adjusted ORs in men and women combined (P for trend = 0.0107) and women (P for trend = 0.0003), but not in men. Adjusted ORs of the lowest quartile group were significantly higher than the highest group in men and women combined (OR = 1.39, 95 % CI: 1.06-1.81) and women (OR = 1.89, 95 % CI: 1.31-2.72).

LIMITATION

Depressive symptoms were self-reported.

CONCLUSIONS

Low vitamin D levels were associated with a high risk of depressive symptoms, especially in women. Women are thus considered a major target for preventing vitamin D deficiency to address depression.

Is Sunshine Vitamin Related to Adolescent Depression? A Cross-Sectional Study of Vitamin D Status and Depression Among Rural Adolescents

BACKGROUND

Adolescence is the phase of rapid transition of the body. The requirement of all minerals and vitamins changes in this phase of life so does Vitamin D. Despite Vitamin D being abundantly available, its deficiency, which can cause innumerable side effects on the body, is extremely common among the general population.  Material and methods: The present study was a cross-sectional study carried out from January 2021 to July 2022 for two years at various government rural high schools in Kolar, Karnataka, India. All adolescents who were aged 11-18 years and studying in 9th and 10th standards were included in the study after consent and assent. Adolescent boys and girls with any pre-existing mental health illness were excluded from the study. To assess depression, Beck's Depression Inventory (BDI-II) was used. Vitamin D3 levels were assessed by using VITROS Immunodiagnostic products using a 25-OH Total reagent pack. All data were entered in a Microsoft Excel sheet (Redmond, USA) and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. To check for the association between factors, Chi-square was applied with a level of significance defined as a p-value less than 0.05.

RESULTS

Out of 451 students, 272 (60.3%) belonged to the 15-year age group, 224 (49.7%) were boys, 235 (52.1%) were studying in 10th standard, 323 (71.6 %) belonged to nuclear families, 379 (84%) were non-vegetarian by diet, 222 (49.2%) had sun exposure in the afternoon, and 156 (34.6%) had a sun exposure of fewer than 60 minutes, 133 (29.5%) had severe depression according to Beck's Depression Inventory-II. One hundred sixty-two (35.9%) had insufficient Vitamin D3 levels (12-20 ng/ml), and 66 (14.6%) had deficient levels of Vitamin D3 (less than 12 ng/dl). There was a statistically significant association between depression and Vitamin D3 levels.

CONCLUSION

There are innumerable causes of adolescent depression. The present study shows Vitamin D levels were statistically associated with depression among adolescents. Vitamin D supplementation of at least 600 international units, which is the recommended dietary allowance (RDA), could be beneficial in tackling Vitamin D to sufficiency status (20-100 ng/ml) and also indirectly address Adolescent Depression. Better study designs, like randomized control trials showing Vitamin D intervention and its possible curative role in adolescent depression, are required to establish the causal association.

Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color

Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.

Relationship between serum 25 hydroxyvitamin D (25(OH)D) levels and mental health in shift female nurses

The nurses work long hours and in various shifts, and often accompanied by depression, fatigue, and sleep disorders. Many studies have found that 25 hydroxyvitamin D (25(OH)D) is related to mental health. We aimed to investigate the relationship between depression, sleep problems, fatigue, and serum 25(OH)D levels in shift nurses. We recruited 34 day-shift, 30 evening-shift and 31 night-shift nurses. The Beck Depression Inventory II (BDI-II), Numerical Rating Scale and General Sleep Disturbance Scale to evaluate the levels of depression, sleep problems, fatigue. Blood samples (20 ml) were collected under a fasting state to determine basic biochemistry and inflammatory parameters. In central of Taiwan, approximately 96.1% of shift nurses had deficient (< 20 ng/ml) (45 females and 1 male) and inadequate (20-29 ng/ml) (39 females and 2 male) 25(OH)D levels. Approximately 84.2% of shift nurses experienced fatigue. In sleep disturbance, night-shift nurses experienced significantly more severe sleep disturbance than day-shift and evening-shift nurses. However, no significant correlation was observed between 25(OH)D levels and mental health when the 25(OH)D level was categorized. 25(OH)D deficiency, sleep disturbance, depression, and fatigue were common in shift female nurses, but it was not possible to demonstrate the impact of 25(OH)D deficiency on the mental health of shift nurses in Taiwan.

Changes in vitamin D levels and depressive symptoms in later life in England

Inadequate vitamin D levels have been associated with increased risk of depression. However, most of these studies are cross-sectional and failed to investigate the effect of changes in vitamin D levels. This study aimed to investigate the longitudinal association of changes in serum 25-hydroxyvitamin D levels with depressive symptoms in 3365 participants of the English Longitudinal Study of Ageing, a large nationally-representative study of older adults. Based on their vitamin D levels at baseline and follow-up (sufficient ≥ 50 nmol/L; insufficient < 50 nmol/L), participants were classified as follows: with sufficient levels at both waves; with sufficient levels at baseline but not at follow-up; with insufficient levels at baseline but ≥ 50 nmol/L at follow-up; and with levels < 50 nmol/L at each time point. Depressive symptoms were measured using the 8-point CES-D scale. Data were analysed using logistic regression models. Compared with those with sufficient levels of vitamin D at both waves, only those with insufficient levels throughout were more likely to report elevated depressive symptoms (OR = 1.39, 95% CI = 1.00–1.93). Becoming or no longer being vitamin D deficient was, in the short term, not associated with elevated depressive symptoms. Further evidence is required on whether vitamin D supplementation might contribute to the prevention or treatment of depression as well as on the duration of time for changes in vitamin D levels to lead to detectable changes in depressive symptoms.

Serum Vitamin D and Depressive Symptomatology among Boston-Area Puerto Ricans

BACKGROUND

Low vitamin D status, assessed using serum 25-hydroxyvitamin D [25(OH)D] concentration, has been associated with depression, but research among minority populations, such as Puerto Ricans is limited. We examined the association between serum 25(OH)D and self-reported depressive symptomatology across 3 waves of follow-up in a cohort of Puerto Rican adults residing in Massachusetts.

OBJECTIVES

We evaluated the cross-sectional and longitudinal associations between serum 25(OH)D and self-reported depressive symptoms in the Boston Puerto Rican Health Study (BPRHS) cohort.

METHODS

Participants of the BPRHS were evaluated for depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). Serum 25(OH)D was measured at baseline (n = 1434), year 2 (n = 1218), and year 5 (n = 914). We categorized serum 25(OH)D concentration as sufficient (≥20 ng/mL), insufficient (12 to <20 ng/mL), and deficient (<12 ng/mL). Multivariable linear regression was used for cross-sectional analyses at baseline, and repeated measures mixed effects modeling was used over 3 waves of follow-up for longitudinal analyses. We conducted sensitivity analyses in vitamin D supplement nonusers and participants with complete data on baseline serum 25(OH)D and CES-D at all 3 visits.

RESULTS

Serum 25(OH)D concentration was not associated with CES-D score in cross-sectional analysis [β = -0.85; 95% CI: -2.80, 1.10 for deficient compared with sufficient 25(OH)D; P-trend = 0.59] or in longitudinal analyses over 5 y [β = -0.41; 95% CI: -1.95, 1.13 for deficient compared with sufficient 25(OH)D; P-trend = 0.93]. Results were similar in sensitivity analyses restricted to vitamin D supplement nonusers (n = 1371) and in analyses conducted in participants with complete measures of baseline serum 25(OH)D and CES-D score at all 3 visits (n = 887) [β = -0.12; 95% CI: -1.98, 1.74 for deficient compared with sufficient 25(OH)D; P-trend = 0.93].

CONCLUSIONS

We did not observe a significant association between serum 25(OH)D and depressive symptomatology in the BPRHS cohort.

Serum 25-Hydroxyvitamin D Concentrations Are Associated with Mental Health and Psychosocial Stress in Young Adults

We aimed to test the hypothesis that serum 25-hydroxyvitamin D₃ (25(OH)D) concentration is associated with mental health and life stress measures in young adults and investigate gender and racial disparities in these associations. This study comprised 327 black and white participants. Depression, trait anxiety, perceived stress, and hostility were measured by the following validated instruments: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Cook–Medley Hostility Scale (CMHS). Linear regression was used to estimate correlations between serum 25(OH)D concentration and mental health measurements in the total population and in subgroups stratified by gender and race. In this sample (28.2 ± 3.1 years, 52% female, 53% black), serum 25(OH)D concentration was negatively related to BDI, STAI, PSS, total CMHS score, and the majority of CMHS subscale scores (p-values < 0.05). Stratified by gender, most of these associations remained significant only in women (p-values < 0.05). Stratified by race, higher 25(OH)D concentrations in white participants were significantly related to lower BDI, STAI, PSS, and CMHS-cynicism subscales (p-values < 0.05); 25(OH)D concentrations in the black participants were only inversely associated with CMHS and most CMHS subscales (p-values < 0.05) but not with BDI, STAI, and PSS. We present novel findings of consistent inverse relationships between serum 25(OH)D concentration and various measures of mental health and life stress. Long-term interventional studies are warranted in order to investigate the roles of vitamin D supplementation in the prevention and mitigation of depression, anxiety, and psychological stress in young adults.

Serum 25-Hydroxyvitamin D Levels and Depression in Older Adults: A Dose-Response Meta-Analysis of Prospective Cohort Studies

OBJECTIVE

The association between serum vitamin D and risk of depression in older adults is controversial. We performed a dose-response meta-analysis of prospective cohort studies to examine the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of depression in older population.

METHODS

Studies published before February 2018 in the PubMed, Cochrane Library, Web of Science, PsycINFO, and EMBASE databases were systematically searched. Prospective cohort studies that examined the association between serum 25(OH)D levels and the risk of depression in older adults were included. A random-effects model was used to calculate the pooled hazard ratio and the corresponding 95% confidence intervals. A nonlinear dose-response association was examined using restricted cubic spline functions.

RESULTS

Six prospective studies covering 16,287 older adults with 1,157 cases of depression were included and analyzed. The pooled hazard ratio of depression for per 10-ng/mL increment in serum 25(OH)D was 0.88 (95% confidence intervals: 0.78-0.99, I² = 79.0%, p <0.001 for heterogeneity). A linear dose-response association between serum 25(OH)D concentrations and incident depression was observed (p = 0.96 for nonlinearity).

CONCLUSION

Serum 25(OH)D concentration is negatively associated with the risk of depression in older adults. This meta-analysis suggests that increasing 25(OH)D levels may be a useful approach to reduce the risk of depression in older adults and highlights the need for further large-scale clinical studies.

Associations Between Vitamin D Levels and Depressive Symptoms in Later Life: Evidence From the English Longitudinal Study of Ageing (ELSA)

Background

A possible role of vitamin D in depression has received considerable attention, especially given the significant disability, mortality, and healthcare costs associated to depression and the high prevalence of vitamin D deficiency.

Methods

We investigated the cross-sectional associations between serum 25-hydroxyvitamin D (25OHD) levels and depressive symptoms (CES-D) in 5,607 older adults from the English Longitudinal Study of Ageing (ELSA).

Results

Overall, there was a significant association between low 25OHD levels and elevated depressive symptoms (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.20–2.07 for the lowest quartile; OR = 1.45, 95% CI = 1.15–1.83 for <30 nmol/L cut-off and OR = 1.34, 95% CI = 1.10–1.62 for the ≤50 nmol/L cut-off) after adjustment for a wide range of covariates of clinical significance. Fully adjusted models showed that women in the lowest (OR = 1.67, 95% CI = 1.20–2.34) and second lowest (OR = 1.68, 95% CI = 1.20–2.35) quartiles of 25OHD as well as those with 25OHD levels <30 nmol/L (OR = 1.40, 95% CI = 1.06–1.86) and ≤50 nmol/L (OR = 1.35, 95% CI = 1.07–1.72) were more likely to report elevated depressive symptoms. For men, however, this association only remained significant for those with 25OHD levels of <30 nmol/L (OR = 1.60, 95% CI = 1.06–2.42) in the fully adjusted models.

Conclusions

The independent and inverse association found between low 25OHD levels and elevated depressive symptoms suggests that vitamin D deficiency may be a risk factor for late-life depression, particularly among women. Whether our findings have any clinical meaning or not, additional data are needed from well-designed randomized controlled trials of vitamin D for the prevention and treatment of late-life depression.

A Longitudinal Study of the Association Between Persistent Pathogens and Incident Depression Among Older U.S. Latinos

Depression is estimated to affect more than 6.5 million Americans 65 years of age and older and compared with non-Latino whites older U.S. Latinos have a greater incidence and severity of depression, warranting further investigation of novel risk factors for depression onset among this population. We used data on 771/1,789 individuals ≥60 years of age from the Sacramento Area Latino Study on Aging (1998-2008) who were tested for cytomegalovirus (CMV), herpes simplex virus, varicella zoster, Helicobacter pylori, Toxoplasma gondii, and C-reactive protein (CRP) and interleukin-6 (IL-6) level. Among those without elevated depressive symptoms at baseline, we examined the association between each pathogen, inflammatory markers and incident depression over up to nearly 10 years of follow-up using discrete-time logistic regression. We found that only CMV seropositivity was statistically significantly associated with increased odds of incident depression (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.00-1.90) in the total sample as well as among women only (OR: 1.70, 95% CI: 1.01-2.86). These associations were not mediated by CRP or IL-6 levels. Our findings suggest that CMV seropositivity may serve as an important risk factor for the onset of depression among older U.S. Latinos, but act outside of inflammatory pathways.

The Relationship Between Serum Concentration of Vitamin D, Total Intracranial Volume, and Severity of Depressive Symptoms in Patients With Major Depressive Disorder

Background: Depression has been linked to vitamin D deficiency. However, little attention was paid to the neural substrate underlying this association. Methods: Fifty patients with major depressive disorder (MDD) were enrolled in this study. High-resolution structural magnetic resonance imaging was performed to calculate total intracranial volume (TIV). Peripheral venous blood samples were collected to measure serum vitamin D concentration. Hamilton Rating Scale for Depression (HAMD) was used to assess severity of depression symptoms. The relationship among TIV, serum vitamin D concentration, and HAMD score was examined using correlation, linear regression, and mediation analyses. Results: In patients with MDD, HAMD score was negatively correlated with TIV and serum vitamin D concentration, and TIV was positively correlated with serum vitamin D concentration. Linear regression analyses showed that TIV and serum vitamin D concentration were significant predictors of HAMD score. Importantly, mediation analysis revealed that TIV significantly mediated the relationship between serum vitamin D concentration and HAMD score. Conclusion: Our findings suggest that TIV may serve as a potential neural biomarker for monitoring responses to adjuvant therapy of vitamin D in patients with MDD.

Vitamin D Status and Depressive Symptoms in Older Adults: A Role for Physical Functioning?

OBJECTIVES

Depressive symptoms and low vitamin D status are common in older persons and may be associated, but findings are inconsistent. This study investigated whether 25-hydroxyvitamin D (25(OH)D) concentrations are associated with depressive symptoms in older adults, both cross-sectionally and longitudinally. We also examined whether physical functioning could explain this relationship, to gain a better understanding of the underlying mechanisms.

METHODS

Data from two independent prospective cohorts of the Longitudinal Aging Study Amsterdam were used: an older cohort (≥65 years, n = 1282, assessed from 1995-2002) and a younger-old cohort (55-65 years, n = 737, assessed from 2002-2009).

MEASUREMENTS

Depressive symptoms were measured at baseline and after 3 and 6 years with the Center of Epidemiological Studies Depression Scale. Cross-sectional and longitudinal linear regression techniques were used to examine the relationship between 25(OH)D and depressive symptoms. The mediating role of physical functioning was examined in the longitudinal models.

RESULTS

Cross-sectionally, associations were not significant after adjustment for confounders. Longitudinally, women in the older cohort with baseline 25(OH)D concentrations up to 75 nmol/L experienced 175 to 24% more depressive symptoms in the following 6 years, compared with women with 25(OH)D concentrations >75 nmol/L. Reduced physical performance partially mediated this relationship. In men and in the younger-old cohort, no significant associations were observed.

CONCLUSIONS

Older women showed an inverse relationship between 25(OH)D and depressive symptoms over time, which may partially be explained by declining physical functioning. Replication of these findings by future studies is needed.

Change in serum 25-hydroxyvitamin D and parallel change in depressive symptoms in Dutch older adults

OBJECTIVES

Previous prospective studies on the association between vitamin D status and depression used a single 25-hydroxyvitamin D (25(OH)D) measurement. We investigated the association between change in serum 25(OH)D and parallel change in depressive symptoms over time in Dutch older adults.

DESIGN

A population-based, prospective study in two cohorts of older men and women from the Longitudinal Aging Study Amsterdam.

METHODS

Serum 25(OH)D concentrations were determined at two time points: in 1995/1996 and 13 years later in the older cohort (aged 65–88y, n = 173) and in 2002/2003 and 6 years later in the younger cohort (55–65 years, n = 450). At these time points, depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale (CES-D). Associations were tested by multiple linear regression analyses.

RESULTS

During follow-up, serum 25(OH)D concentrations increased in 32.4% of the older cohort and in 69.8% of the younger cohort. In the older cohort, change in 25(OH)D was not associated with change in CES-D score. In the younger cohort, no associations were observed in participants with higher baseline 25(OH)D concentrations (>58.6 nmol/L), but in those with lower baseline 25(OH)D concentrations, an increase in 25(OH)D was associated with a decrease in CES-D score (adjusted B per 10 nmol/L 25(OH)D increase: −0.62 (95% CI: −1.17, −0.07)).

Diet, nutrition and the ageing brain: current evidence and new directions

Globally populations are ageing. By 2050, it is estimated that there will be two billion people aged 60 years or over, of which 131 million are projected to be affected by dementia, while depression is predicted to be the second leading cause of disability worldwide by 2020. Preventing or delaying the onset of these disorders should therefore be a public health priority. There is some evidence linking certain dietary patterns, particularly the Mediterranean diet, with a reduced risk of dementia and depression. Specific dietary components have also been investigated in relation to brain health, with emerging evidence supporting protective roles forn-3 PUFA, polyphenols, vitamin D and B-vitamins. At this time, the totality of evidence is strongest in support of a role for folate and the metabolically related B-vitamins (vitamin B12, vitamin B6and riboflavin) in slowing the progression of cognitive decline and possibly reducing the risk of depression in ageing. Future studies incorporating new technologies, such as MRI and magnetoencephalography, offer much promise in identifying effective nutrition interventions that could reduce the risk of cognitive and mental disorders. This review will explore the ageing brain and the emerging evidence linking diet and specific nutrients with cognitive function and depression in ageing, with the potential to develop strategies that could improve quality of life in our ageing population.

Physical Performance and Serum 25(OH)vitamin D Status in Community Dwelling Old Mobility Limited Adults: A Cross-Sectional Study

OBJECTIVES

To examine the potential association between serum 25(OH) vitamin D and the performance on the Short Physical Performance Battery (SPPB) including the sub-components; five repeated chair stands test, 4 meters walk test and balance in older mobility-limited community-dwelling men and women.

DESIGN

A cross sectional study was performed in American and Swedish subjects who were examined for potential participation in a combined exercise and nutrition intervention trial. Logistic regression analysis and linear regression analyses were performed to evaluate the association for 25(OH)D with the overall score on the SBBP, chair stand, gait speed and balance.

PARTICIPANTS

Community-dwelling (mean age 77.6 ± 5.3 years) mobility limited American (n=494) and Swedish (n=116) females (59%) and males.

MEASUREMENTS

The SPPB (0-12 points) includes chair stand (s), gait speed (m/s) and a balance test. Mobility limitation i.e., SPPB score ≤ 9 was an inclusion criterion. A blood sample was obtained to measure serum 25(OH)vitamin D concentrations.

RESULTS

No clear association of 25(OH)D with SPPB scores was detected either when 25(OH)D was assessed as a continuous variable or when categorized according to serum concentrations of <50, 50-75 or <75 nmol/L. However, when analyzing the relationship between 25(OH)D and seconds to perform the chair stands, a significant quadratic relationship was observed. Thus, at serum levels of 25(OH)D above 74 nmol/L, higher concentrations appeared to be advantageous for the chair stand test, whereas for serum levels below 74 nmol/L this association was not observed.

CONCLUSION

This cross- sectional study lacked clear association between serum 25(OH)D and physical performance in mobility limited adults. A potentially interesting observation was that at higher serum levels of 25(OH)D a better performance on the chair stand test was indicated.

Association between low serum 25-hydroxyvitamin D and depression in a large sample of Chinese patients with type 2 diabetes mellitus

BACKGROUND

Because of the absence of data on the direct association between vitamin D and depression in patients with diabetes, we examined the association between vitamin D state (assessed by 25-hydroxyvitamin D [25(OH)D]) and the prevalence of depression in adult patients with type 2 diabetes mellitus(T2DM).

METHOD

Cross-sectional data were obtained from 2786 patients with T2DM recruited from a Chinese diabetes registry. Patients' records were reviewed to obtain data pertaining to age, sex, Body Mass Index (BMI), marital status, level of education, smoking status, duration of diabetes mellitus, use of insulin, and presence of additional illnesses. A multiple logistic regression analysis adjusted for potential confounders was used to assess independent associations between serum levels of 25 (OH)D and depression (defined by the Patient Health Questionnaire-9).

RESULTS

Using the PHQ-9 cutoff value of ≥10, 5.71% (159/2786; 95% CI: 4.85-6.57%) were considered to have depression. The serum 25(OH)D levels were significantly lower in diabetic patients with depression than those patients without depression [10.2(IQR, 7.6-15.2)ng/ml vs. 14.6(IQR, 10.7-19.8)ng/ml, respectively; P<0.0001]. Multivariate logistic regression analysis considering traditional risk factors and other biomarkers showed an inverse relationship between serum 25 (OH)D levels and depression when serum 25 (OH)D were used as a continuous variable (OR, 0.84; 95% CI, 0.77-0.90; P<0.001). Compared with the first quartile of serum 25 (OH)D levels, the second quartile OR for depression was 0.83 (95% CI, 0.75-0.92, P=0.012). For the third and fourth quartiles, it was 0.40 (95% CI, 0.33-0.52, P<0.001) and 0.15 (95% CI, 0.08-0.22; P<0.001), respectively.

CONCLUSIONS

We observed a significant negative association between serum levels of 25 (OH)D and depression in Chinese patients with T2DM.

Vitamin D serum levels are cross-sectionally but not prospectively associated with late-life depression

OBJECTIVE

The evidence for a prospective association of vitamin D deficiency with the occurrence of late-life depression is limited. We aimed to study the long-term association between vitamin D serum levels and depression in a large population-based study of older adults.

METHOD

We included 3251 participants from the Rotterdam Study, aged 55 and older with 32 400 person-years follow-up for depression. Baseline 25-hydroxyvitamin D (25(OH)D) serum levels were analyzed continuously and categorically. Repeated depressive symptoms' questionnaire assessments were used to assess the change of depressive symptoms. Semistructured psychiatric interviews, and GP records were used to assess incident major depressive disorder according to DSM-IV criteria.

RESULTS

Low serum vitamin D levels were cross-sectionally associated with more depressive symptoms. However, low 25(OH)D serum levels were not prospectively associated with change of depressive symptoms (unstandardized beta = 0.02, 95% CI = -0.23; 0.26) or incident MDD (hazard ratio = 0.95, 95% CI = 0.86; 1.05).

CONCLUSION

We observed a cross-sectional but no prospective association between serum vitamin D levels and depression. A cross-sectional association in the absence of the longitudinal association can mostly be attributed to reverse causality or residual confounding. Probably, vitamin D deficiency is not an independent risk factor for depression but co-occurs with late-life depression.

Is Hypovitaminosis D Associated with Stress Perception in the Elderly? A Nationwide Representative Study in Korea

Hypovitaminosis D and stress are common problems among the elderly. The aim of this cross-sectional nationally representative study was to evaluate the association between hypovitaminosis D and stress perception using large-scale nationally representative data from the Korea National Health and Nutrition Examination Survey (2012-2013). In our study, a total of 1393 elders (≥65 years old) were included to evaluate the association between hypovitaminosis D and stress perception. Serum 25-hydroxyvitamin D levels were determined using radioimmunoassay, and perceived stress status was assessed by a self-reporting questionnaire. The association between hypovitaminosis D and stress perception according to sex was examined using logistic regression analysis. After multivariate adjustment for sociodemographic and lifestyle factors and comorbidities, hypovitaminosis D was significantly associated with perceived stress (odds ratio, 2.73; 95% confidence interval, 1.10-6.77; p = 0.029) among women; however, this association was not significant among men. Hypovitaminosis D was a risk factor for higher stress perception in older Korean women. Even though the role of vitamin D in stress perception is still unclear, we suggest screening for hypovitaminosis D among the elderly.

Estimated economic benefit of increasing 25-hydroxyvitamin D concentrations of Canadians to or above 100 nmol/L

Mounting evidence from observational and clinical trials indicates that optimal vitamin D reduces the risk of many diseases. We used observational studies and recent data on 25-hydroxyvitamin D [25(OH)D] concentrations of Canadians from Cycle 3 of the Canadian Health Measures Survey to estimate the reduction in disease incidence, mortality rates, and the total economic burden (direct plus indirect) of disease if 25(OH)D concentrations of all Canadians were raised to or above 100 nmol/L. Recently, the mean 25(OH)D concentration of Canadians varied depending on age and season (51-69 nmol/L), with an overall mean of 61 nmol/L. The diseases affected by 25(OH)D concentration included cancer, cardiovascular disease, dementia, diabetes mellitus, multiple sclerosis, respiratory infections, and musculoskeletal disorders. We used 25(OH)D concentration-health outcome relations for breast cancer and cardiovascular disease and results of clinical trials with vitamin D for respiratory infections and musculoskeletal disorders to estimate the reductions in disease burden for increased 25(OH)D concentrations. If all Canadians attained 25(OH)D concentrations>100 nmol/L, the calculated reduction in annual economic burden of disease was $12.5 ± 6 billion on the basis of economic burdens for 2016 and a reduction in annual premature deaths by 23,000 (11,000-34,000) on the basis of rates for 2011. However, the effects on disease incidence, economic burden, and mortality rate would be phased in gradually over several years primarily because once a chronic disease is established, vitamin D affects its progression only modestly. Nevertheless, national policy changes are justified to improve vitamin D status of Canadians through promotion of safe sun exposure messages, vitamin D supplement use, and/or facilitation of food fortification.

Vitamin D supplementation to prevent depression and poor physical function in older adults: Study protocol of the D-Vitaal study, a randomized placebo-controlled clinical trial

BACKGROUND

Depressive symptoms and decreased physical functioning are interrelated conditions and common in older persons, causing significant individual and societal burden. Evidence suggests that vitamin D supplementation may be beneficial for both mental and physical functioning. However, previous randomized controlled trials have yielded inconsistent results and often had suboptimal designs. This study examines the effect of vitamin D supplementation on both depressive symptoms and physical functioning in a high-risk population of older persons with low vitamin D status.

METHODS/DESIGN

The D-Vitaal study is a randomized, double-blind, placebo-controlled trial investigating the effects of a daily dose of 1200 IU vitamin D3 versus placebo for one year on depressive symptoms and physical functioning (primary outcomes) in older adults. Participants (N = 155, age 60-80 years) were recruited from the general population. Eligibility criteria included the presence of depressive symptoms, ≥1 functional limitation and serum 25-hydroxyvitamin D levels between 15 and 50/70 nmol/L (depending on season). Secondary outcomes include incidence of major depressive disorder, anxiety symptoms, health-related quality of life, cognitive function and cost-effectiveness of the intervention.

DISCUSSION

With this study, we aim to elucidate the effects of vitamin D supplementation on depressive symptoms and physical functioning in older persons who are at high risk of developing more substantial mental and physical problems. If effective, vitamin D supplementation can be a preventive intervention strategy that is easy to implement in the primary care setting.

TRIAL REGISTRATION

Netherlands Trial Register NTR3845. Registered 6 February 2013.

Vitamin D and Age-Related Health Outcomes: Movement, Mood, and Memory

It has long been recognized that vitamin D plays an important role in calcium homeostasis and musculoskeletal health. More recent evidence supports a role of vitamin D in physical and cognitive function and depressive symptoms through direct effects on skeletal muscle and the brain as well as indirectly through its reported roles in chronic conditions such as cardiovascular disease and diabetes, conditions that frequently lead to declines in physical and cognitive function and depressed mood. The purpose of this review is to summarize the prospective cohort and randomized controlled trial evidence for vitamin D on physical and cognitive function and depressed mood in older adults. Results from both prospective cohort studies and randomized controlled trials of vitamin D supplementation are mixed. Thus, controversy remains over the optimal vitamin D concentration for physical and cognitive function and depressed mood and whether vitamin D supplementation is beneficial for these outcomes.

Nutritional Vulnerability in Older Adults: A Continuum of Concerns

A nutritionally vulnerable older adult has a reduced physical reserve that limits the ability to mount a vigorous recovery in the face of an acute health threat or stressor. Often this vulnerability contributes to more medical complications, longer hospital stays, and increased likelihood of nursing home admission. We have characterized in this review the etiology of nutritional vulnerability across the continuum of the community, hospital, and long term care settings. Frail older adults may become less vulnerable with strong, consistent, and individualized nutritional care. Interventions for the vulnerable older adult must take their nutritional needs into account to optimize resiliency in the face of the acute and/or chronic health challenges they will surely face in their life course.