Associations between serum 25-hydroxyvitamin D concentrations and multiple health conditions, physical performance measures, disability, and all-cause mortality: the Concord Health and Ageing in Men Project

Association of serum 25-hydroxyvitamin d concentrations with all-cause and cause-specific mortality among individuals with depression: A cohort study

BACKGROUND

Limited evidence exists on the relationship between vitamin D status and mortality in depressed patients.

METHODS

This study investigates serum 25-hydroxyvitamin D [25(OH)D] concentrations in 8417 adults with depression among the National Health and Nutrition Examination Survey (NHANES, 2005-2018). Mortality outcomes were assessed through National Death Index records up to December 31, 2019. Cox proportional risk models estimated risk ratios (HR) and 95 % confidence intervals (CI) for all-cause, cardiovascular disease (CVD), and cancer mortality. Restricted cubic spline analyses explored the nonlinear association of serum 25(OH)D levels with mortality, using the likelihood ratio test for nonlinearity.

RESULTS

The weighted mean serum 25(OH)D level was 66.40 nmol/L (95 % CI: 65.8, 67.0), with 36.3 % having deficient vitamin D (<50 nmol/L [20 ng/mL]). Over an average 7.16-year follow-up, 935 deaths were documented, including 296 CVD deaths and 191 cancer deaths. Higher serum 25(OH)D levels were associated with reduced all-cause mortality (HRs 0.55-1.00, p trend = 0.006) and cancer-specific mortality (HRs 0.36-1.00, p trend = 0.015) after multivariate adjustment. The relationship between serum 25(OH)D and all-cause mortality exhibited a nonlinear pattern (P for nonlinearity <0.001), with a 34 % lower risk for each unit increase in natural log-transformed 25(OH)D levels. Significant interactions were observed with age, antidepressant use, and diabetes status.

CONCLUSIONS

Higher serum 25(OH)D levels were associated with decreased all-cause and cancer-specific mortality in depressed adults, particularly among younger individuals and those using antidepressants or without diabetes. Further research is essential to understand mechanisms and interventions related to vitamin D in depression.

Serum Vitamin D Levels in Relation to Hypertension and Pre-hypertension in Adults: A Systematic Review and Dose–Response Meta-Analysis of Epidemiologic Studies

Background

Findings of observational studies that evaluated the association of serum vitamin D status and high blood pressure were contradictory. This meta-analysis of epidemiologic studies assessed the relation of serum vitamin D levels to hypertension (HTN) and pre-hypertension in adults.

Methods

We conducted a systematic search of all published articles up to March 2021, in four electronic databases (MEDLINE (PubMed), Web of Science (ISI), Embase and Scopus), and Google scholar. Seventy epidemiologic studies (10 prospective cohort, one nested case–control, and 59 cross-sectional investigations) that reported relative risks (RRs), odds ratios (ORs), hazard ratios, or prevalence ratios with 95% CIs for HTN or pre-hypertension in relation to serum vitamin D concentrations in adults were included in the analysis.

Results

In prospective studies, a 16% decrease in risk of hypertension was observed in participants with high levels of serum vitamin D compared to low levels (RR: 0.84; 95%CI: 0.73, 0.96; 12 effect sizes). Dose–response analysis in prospective studies revealed that each 25 nmol/L increase in serum vitamin D concentrations resulted in 5% reduced risk of HTN (RR: 0.95; 95% CI: 0.90, 1.00). Also, a significant nonlinear relationship between serum vitamin D levels and HTN was found (P_nonlinearity < 0.001). In cross-sectional investigations, highest vs. lowest level of serum vitamin D was related to reduced odds of HTN (OR: 0.84; 95%CI: 0.79, 0.90; 66 effect sizes) and pre-hypertension (OR: 0.75; 0.95%CI: 0.68, 0.83; 9 effect sizes). Dose–response analysis in these studies showed that each 25 nmol/L increase in serum vitamin D levels was related to a significant 6% reduction in odds of hypertension in all populations (RR: 0.94; 95%CI: 0.90, 0.99) and 3% in studies with representative populations (RR: 0.97; 95%CI: 0.95, 0.99).

Conclusion

This meta-analysis of epidemiologic studies disclosed that serum vitamin D concentrations were inversely related to the risk of HTN in adults, in a dose–response manner in both prospective cohort and cross-sectional studies.

Systematic Review Registration:http://www.crd.york.ac.uk/Prospero, identifier: CRD42021251513.

How to Increase Muscle Mass in Critically Ill Patients: Lessons Learned from Athletes and Bodybuilders

PURPOSE OF REVIEW

Decades of research on nutrition and exercise on athletes and bodybuilders has yielded various strategies to promote anabolism and improve muscle health and growth. We reviewed these interventions in the context of muscle loss in critically ill patients.

RECENT FINDINGS

For critically ill patients, ensuring optimum protein intake is important, potentially using a whey-containing source and supplemented with vitamin D and leucine. Agents like hydroxyl β-methylbutyrate and creatine can be used to promote muscle synthesis. Polyunsaturated fatty acids stimulate muscle production as well as have anti-inflammatory properties that may be useful in critical illness. Adjuncts like oxandralone promote anabolism. Resistance training has shown mixed results in the ICU setting but needs to be explored further with specific outcomes. Critically ill patients suffer from severe proteolysis during hospitalization as well as persistent inflammation, immunosuppression, and catabolism syndrome after discharge. High protein supplementation, ergogenic aids, anti-inflammatories, and anabolic adjuncts have shown potential in alleviating muscle loss and should be used in intensive care units to optimize patient recovery.

Vitamin D3 supplementation does not enhance the effects of resistance training in older adults

BACKGROUND

Lifestyle therapy with resistance training is a potent measure to counteract age-related loss in muscle strength and mass. Unfortunately, many individuals fail to respond in the expected manner. This phenomenon is particularly common among older adults and those with chronic diseases (e.g. chronic obstructive pulmonary disease, COPD) and may involve endocrine variables such as vitamin D. At present, the effects of vitamin D supplementation on responses to resistance training remain largely unexplored.

METHODS

Ninety-five male and female participants (healthy, n = 71; COPD, n = 24; age 68 ± 5 years) were randomly assigned to receive either vitamin D3 or placebo supplementation for 28 weeks in a double-blinded manner (latitude 61°N, September-May). Seventy-eight participants completed the RCT, which was initiated by 12 weeks of supplementation-only (two weeks with 10 000 IU/day, followed by 2000 IU/day), followed by 13 weeks of combined supplementation (2000 IU/day) and supervised whole-body resistance training (twice weekly), interspersed with testing and measurements. Outcome measures included multiple assessments of muscle strength (nvariables  = 7), endurance performance (n = 6), and muscle mass (n = 3, legs, primary), as well as muscle quality (legs), muscle biology (m. vastus lateralis; muscle fibre characteristics, transcriptome), and health-related variables (e.g. visceral fat mass and blood lipid profile). For main outcome domains such as muscle strength and muscle mass, weighted combined factors were calculated from the range of singular assessments.

RESULTS

Overall, 13 weeks of resistance training increased muscle strength (13% ± 8%), muscle mass (9% ± 8%), and endurance performance (one-legged, 23% ± 15%; whole-body, 8% ± 7%), assessed as weighted combined factors, and were associated with changes in health variables (e.g. visceral fat, -6% ± 21%; [LDL]serum , -4% ± 14%) and muscle tissue characteristics such as fibre type proportions (e.g. IIX, -3% points), myonuclei per fibre (30% ± 65%), total RNA/rRNA abundances (15%/6-19%), and transcriptome profiles (e.g. 312 differentially expressed genes). Vitamin D3 supplementation did not affect training-associated changes for any of the main outcome domains, despite robust increases in [25(OH)D]serum (∆49% vs. placebo). No conditional effects were observed for COPD vs. healthy or pre-RCT [25(OH)D]serum . In secondary analyses, vitamin D3 affected expression of gene sets involved in vascular functions in muscle tissue and strength gains in participants with high fat mass, which advocates further study.

CONCLUSIONS

Vitamin D3 supplementation did not affect muscular responses to resistance training in older adults with or without COPD.

Serum 25-hydroxyvitamin D in relation to disability in activities of daily living, mobility, and objective physical functioning among Chinese older adults

OBJECTIVES

Vitamin D deficiency is common among older adults, but its association with physical function is not fully understood. The aim of this study was to investigate the associations between serum 25-hydroxyvitamin D and disability in activities of daily living (ADL), mobility, and objective physical functioning among Chinese older adults.

METHODS

We used cross-sectional data of 2225 older adults (≥65 years) who participated in the 2011/2012 main survey of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the 2012 biomarker sub-study. Serum levels of 25-hydroxyvitamin D were measured by enzyme immunoassay. Outcomes included ADL disability, mobility disability, and disability in three objective physical examinations (standing-up from a chair, picking-up a book from the floor, and turning-around 360°).

RESULTS

The multiple regression models suggested that participants in the serum 25-hydroxyvitamin D deficiency group had higher odds of ADL disability (OR: 4.08; 95% confidence interval (CI): 2.81, 5.92), mobility disability (OR: 1.59; 95% CI: 1.05, 2.41), and disability in standing-up from a chair (OR: 2.43; 95% CI: 1.60, 3.69), picking-up a book from the floor (OR: 3.09; 95% CI: 2.07, 4.60), and turning-around 360° (OR: 3.09; 95% CI: 2.07, 4.60). Subgroup analyses revealed that some of the above associations (particularly those with mobility disability and disability in turning-around 360°) were only statistically significant among the oldest-old.

CONCLUSIONS

Among the oldest-old in China, serum 25-hydroxyvitamin D deficiency was associated with disability in ADL, mobility, and objective physical functioning, highlighting the importance of managing the serum 25-hydroxyvitamin D level to promote healthy aging.

Association of Serum 25-Hydroxyvitamin D Deficiency with Risk of Incidence of Disability in Basic Activities of Daily Living in Adults >50 Years of Age

BACKGROUND

Vitamin D deficiency compromises muscle function and is related to the etiology of several clinical conditions that can contribute to the development of disability. However, there are few epidemiological studies investigating the association between vitamin D deficiency and the incidence of disability.

OBJECTIVES

We aimed to assess whether vitamin D deficiency is associated with the incidence of disability in basic activities of daily living (BADL) and to verify whether there are sex differences in this association.

METHODS

A 4-y follow-up study was conducted involving individuals aged 50 y or older who participated in ELSA (English Longitudinal Study of Ageing). The sample consisted of 4814 participants free of disability at baseline according to the modified Katz Index. Vitamin D was assessed by serum 25-hydroxyvitamin D [25(OH)D] concentrations and the participants were classified as sufficient (>50 nmol/L), insufficient (>30 to ≤50 nmol/L), or deficient (≤30 nmol/L). Sociodemographic, behavioral, and clinical characteristics were also investigated. BADL were re-evaluated after 2 and 4 y of follow-up. The report of any difficulty to perform ≥1 BADL was considered as an incident case of disability. Poisson models stratified by sex and controlled for sociodemographic, behavioral, and clinical characteristics were carried out.

RESULTS

After 4-y follow-up, deficient serum 25(OH)D was a risk factor for the incidence of BADL disability in both women (IRR: 1.53; 95% CI: 1.16, 2.03) and men (IRR: 1.44; 95% CI: 1.02, 2.02). However, insufficient serum 25(OH)D was not a risk factor for the incidence of BADL disability in either men or women.

CONCLUSIONS

Independently of sex, deficient serum 25(OH)D concentrations were associated with increased risk of incidence of BADL disability in adults >50 y old and should be an additional target of clinical strategies to prevent disability in these populations.

How to Improve the Functional Capacity of Frail and Pre-Frail Elderly People? Health, Nutritional Status and Exercise Intervention. The EXERNET-Elder 3.0 Project

Aging is associated with the impairment of health and functional capacity, and physical exercise seems to be an effective tool in frailty prevention and treatment. The purpose of this study was to present the methodology used in the EXERNET-Elder 3.0 project that aims to evaluate the immediate and residual effects and of a multicomponent exercise training program called Elder-fit on frailty, fitness, body composition and quality of life, and also to analyse a possible dietary intake interaction according to health and metabolic status. A total of 110 frail and pre-frail elders participated in this study and were divided into a control group (CG = 52) and an intervention group (IG = 58). The IG performed a supervised multicomponent exercise training program of 6 months and 3 days per week, which included strength, endurance, balance, coordination and flexibility exercises, while the CG continued with their usual daily activities. Both groups received four speeches about healthy habits along the project. Four evaluations were performed: at baseline, after 3 months of training, at the end of the training program (6 months) and 4 months after the program had ended to examine the effects of detraining. Evaluating the efficacy, safety and feasibility of this program will help to develop efficacious physical interventions against frailty. Further, protocols should be described accurately to allow exercise programs to be successfully replicated.

The relationship of serum 25-hydroxyvitamin D concentration with clinical variables in patients with oropharyngeal dysphagia

BACKGROUND & AIMS

The relationship between vitamin D and oropharyngeal dysphagia (OD) is still poorly understood. The aim of this study was to evaluate 25-hydroxyvitamin D [25(OH)D] concentration in patients with OD and to verify its association to nutritional status, functional independence measure (FIM), time of clinical signs (TCS) and OD severity. This is a cross-sectional study conducted with outpatients. Body mass index (BMI), FIM, TCS, causes of OD, comorbidities, penetration-aspiration scale (PAS) and severity scale were evaluated.

METHODS

A multiple linear regression and effect size were performed to evaluate the association between serum 25(OH)D concentration and independent variables.

RESULTS

Forty-eight participants were included, with a mean age of 60.1 ± 15.3 years. The mean of the 25(OH)D concentration was 26.10 ± 12.0 ng/mL. The prevalence of hypovitaminosis D (<30 ng/mL) was 73%. In the multiple linear regression analysis (adjusted for sex, age, BMI, dietary intake and solar radiation), 25(OH)D concentration was significantly related with the TCS (p = 0.01, f² = 0.48). Patients with hypovitaminosis D had a moderate effect (p = 0.08, δ = 0.36) for a lower FIM score.

CONCLUSIONS

These findings indicate that serum 25(OH)D concentration may be related to the TCS and the functional capacity of patients with OD.

The Prevalence and Determinants of Vitamin D Inadequacy among U.S. Older Adults: National Health and Nutrition Examination Survey 2007-2014

Background

Older adults (i.e., adults aged ≥ 60 years) are at higher risk of vitamin D deficiency compared to younger adults as a result of inadequate dietary vitamin D intake and limited exposure to sunlight. Thus, the present study aimed to describe the prevalence of vitamin deficiency and inadequacy among U.S. adults aged ≥ 60 years and the effect of vitamin D supplementation on 25, hydroxyvitamin D (25(OH)D) and its metabolites concentrations.

Methods

The present analysis was based on data from 6,261 participants in the National Health and Nutrition Examination Survey cycles 2007/2008 through 2013/2014. The prevalence of vitamin D deficiency and inadequacy was described according to demographic, behavioral, and health characteristics. Vitamin D deficiency was defined as 25(OH)D < 30 nmol/L; and vitamin D inadequacy was defined as < 50 nmol/L. Logistic regression models were assembled to examine the independent association of participants characteristics and the odds of having 25(OH)D inadequacy. Similarly, general linear models were used to assess the effect of vitamin D supplementation doses on 25(OH)D and its metabolites concentrations.

Results

The prevalence of 25(OH)D deficiency and inadequacy was 4.0% (standard error (SE), 0.4) and 17.4% (SE, 0.8), respectively. In general, the prevalence of 25(OH)D deficiency and inadequacy increased significantly among participants examined during the fall and winter months, women, non-Hispanic black patients, obese subjects, smokers, those physically inactive, and older adults with a daily vitamin D intake < 400 IU. After adjustment for potential confounders, subjects examined during the fall and winter months, females, non-Hispanic blacks, obesity, having a sedentary lifestyle, smokers, and a total vitamin D intake < 400 IU/day were variables significantly associated with increased odds of having vitamin D inadequacy. Notably, vitamin D supplement doses between 400 and 800 IU or > 800 IU/day were significantly correlated with higher 25(OH)D₃ concentrations considered as sufficient. 

Conclusion

25(OH)D inadequacy remains prevalent among U.S. older adults. Notably, optimal 25(OH)D₃ concentrations were consistently seen among vitamin D supplement users. Despite this finding, nearly half of the participants did not take vitamin D supplements. Thus, vitamin D supplementation should be considered an effective strategy to maintain adequate 25(OH)D status among older adults. 

Plasma 25-Hydroxyvitamin D Concentrations Are Inversely Associated with All-Cause Mortality among a Prospective Cohort of Chinese Adults Aged ≥80 Years

BACKGROUND

High concentrations of plasma 25-hydroxyvitamin D [25(OH)D], a marker of circulating vitamin D, have been associated with a lower risk of mortality in epidemiologic studies of multiple populations, but the association for Chinese adults aged ≥80 y (oldest old) remains unclear.

OBJECTIVE

We investigated the association between plasma [25(OH)D] concentration and all-cause mortality among Chinese adults aged ≥80 y.

DESIGN

The present study is a prospective cohort study of 2185 Chinese older adults (median age: 93 y). Prospective all-cause mortality data were analyzed for survival in relation to plasma 25(OH)D using Cox proportional hazards regression models, with adjustments for potential sociodemographic and lifestyle confounders and biomarkers. The associations were measured with HR and 95% CIs.

RESULTS

The median plasma 25(OH)D concentration was 34.4 nmol/L at baseline. Over the 5466 person-year follow-up period, 1100 deaths were identified. Men and women were analyzed together as no effect modification by sex was found. After adjusting for multiple potential confounders, the risk of all-cause mortality decreased as the plasma 25(OH)D concentration increased (P-trend <0.01). Compared with the lowest age-specific quartile of plasma 25(OH)D, the adjusted HRs for mortality for the second, third, and fourth age-specific quartiles were 0.72 (95% CI: 0.57, 0.90), 0.73 (95% CI: 0.58, 0.93), and 0.61 (95% CI: 0.47, 0.81), respectively. The observed associations were broadly consistent across age and other subgroups. Sensitivity analyses generated similar results after excluding participants who died within 2 y of follow-up or after further adjustment for ethnicity and chronic diseases.

CONCLUSIONS

A higher plasma 25-hydroxyvitamin D concentration was associated with a reduced risk of all-cause mortality among Chinese adults aged ≥80 y. This observed inverse association warrants further investigation in randomized controlled trials testing vitamin D supplementation in this age group.

25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study

Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population.

INTRODUCTION

Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units.

METHODS

We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models.

RESULTS

We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5-18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R² = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]).

CONCLUSIONS

In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.

Vitamin D Status and Mortality: A Systematic Review of Observational Studies

Epidemiological evidence suggests that vitamin D deficiency is associated with increased mortality, but it is unclear whether this is explained by reverse causation, and if there are specific causes of death for which vitamin D might be important. We conducted a systematic review of observational studies investigating associations between circulating 25-hydroxyvitamin D (25(OH)D) concentration and all-cause or cause-specific mortality in generally healthy populations. Relevant studies were identified using PubMed and EMBASE searches. After screening 722 unique records and removing those that were ineligible, 84 articles were included in this review. The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality. This association appeared to be non-linear, with progressively lower mortality with increasing 25(OH)D up to a point, beyond which there was no further decrease. There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases, while for cardiovascular mortality, there is weak evidence of an association in observational studies, which is not supported by the data from intervention or Mendelian randomization studies. The relationship between vitamin D status and other causes of death remains uncertain due to limited data. Larger long-term studies are required to clarify these associations.

Combined Effect of Dynapenia (Muscle Weakness) and Low Vitamin D Status on Incident Disability

BACKGROUND AND OBJECTIVE

There is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability.

DESIGN

Prospective cohort study.

SETTINGS

English Longitudinal Study of Aging.

PARTICIPANTS

A total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline.

MEASUREMENTS

The baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression.

RESULTS

The fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99-1.74), 1.77 for dynapenia only (95% CI 1.08-2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28-2.94).

CONCLUSIONS

Dynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up.

Design Features of Randomized Clinical Trials of Vitamin D and Falls: A Systematic Review

Recent guidelines have advocated against the use of vitamin D supplementation as a means to prevent falls in older adults. However, meta-analyses of the available trials have reached divergent conclusions, and the key design features of these trials have not been well characterized. We conducted a systematic review of 30 randomized trials that reported the effects of vitamin D supplements on falls. Trials were identified by reviewing references of published meta-analyses and updated with a systematic PubMed search. We assessed three key design features: (1) recruitment of participants with vitamin D deficiency or insufficiency; (2) provision of daily oral vitamin D supplementation; and (3) utilization of highly sensitive at-event falls ascertainment. The trials enrolled a median of 337 (IQR: 170-1864) participants. Four (13.3%) trials restricted enrollment to those who were at least vitamin D insufficient, 18 (60.0%) included at least one arm providing daily supplementation, and 16 (53.3%) used at-event reporting. There was substantial heterogeneity between trials, and no single trial incorporated all three key design features. Rather than concluding that vitamin D is ineffective as a means to prevent falls, these findings suggest that existing trial evidence is insufficient to guide recommendations on the use of vitamin D supplements to prevent falls.

Prevalence of vitamin D insufficiency and evidence for disease prevention in the older population

The prevalence of vitamin D insufficiency, usually assessed by the analysis of circulating 25-hydroxyvitamin D (25[OH])D), is very high in the aging German population. An important factor that reduces endogenous vitamin D synthesis in older persons is physical inactivity or care-dependency that limits the time spent outside. Additionally, it has been suggested that the age-dependent decline in the glomerular filtration rate is associated with a reduced production of bioactive calcitriol. As this phenomenon is not detectable by the assessment of 25(OH)D, it is necessary to analyze the level of parathyroid hormone as a marker of calcitriol function. Because 25(OH)D levels are highly correlated with an active and healthy life style, data from epidemiological studies are not necessarily suitable to elucidate the role of vitamin D in disease prevention. Recently published meta-analyses of randomized controlled trials (RCTs) showed moderate effects of vitamin D supplementation on fracture risk and found that vitamin D was more effective when administered in combination with calcium. The role of vitamin D in the prevention of falls and frailty remains unclear. Much evidence has demonstrated the beneficial effects of vitamin D on respiratory tract infections and asthma, which are very relevant health issues in the older population. To conclude, vitamin D, particularly combined with calcium, has moderately beneficial effects on the skeletal system and is useful for the prevention of respiratory tract infections.

Latent Class Analysis: a new vision of the phenomenon of depression in elderly men in the Brazilian Northeast

Abstract Objective: to identify the prevalence of depression in elderly men and associated factors using Latent Class Analysis. Method: a cross-sectional, epidemiological study evaluating 162 Primary Care users resident in the community in Recife, Brazil, was carried out. The Yesavage Geriatric Depression Scale was used as a screening instrument. The study was based on descriptive analysis and Latent Class Analysis, which allows the indirect measurement of the phenomenon of Depression by measuring the latent phenomenon of depression through 15 directly observed questions/answers from the scale used followed by ordinal logistic regression. Results: Elderly men with up to four years of schooling had a 2.43 times greater chance of developing depression. Those with normal levels of cortisol were less likely to become depressed while elderly men with low levels of Vitamin D and testosterone and high levels of thyroid stimulating hormones (TSH) were more likely to be depressed. The prevalence of the highest level of depression in the study population was 29% and was associated with low levels of education and alterations in the clinical data investigated. Conclusion: The study concluded that Latent Class Analysis allowed an innovative perspective of the phenomenon of depression and its relationship with associated factors, allowing a better and broader approach to this phenomenon in clinical practice.

Prevalence of clinically relevant muscle weakness and its association with vitamin D status among older adults in Ecuador

BACKGROUND

Muscle weakness and 25-hydroxyvitamin D (25(OH)D) deficiency have been associated with adverse outcomes among older adults. However, little is known about the relationship between clinically relevant muscle weakness and 25(OH)D levels in Ecuador.

AIMS

To examine the prevalence of muscle weakness and its association with 25(OH)D status among subjects aged 60 years and older in Ecuador.

METHODS

The present study was based on data from 2205 participants in the first National Survey of Health, Wellbeing, and Aging. The Foundation for the National Institute of Health Sarcopenia Project criteria was used to examine muscle weakness prevalence rates. Gender-specific general linear and logistic regression models adjusted for potential confounders were created to compare mean 25(OH)D concentrations and 25(OH)D deficiency across muscle strength categories, respectively.

RESULTS

An estimated 32.2% of women and 33.4% of men had evidence of clinically relevant muscle weakness in Ecuador. In general, increased muscle weakness prevalence rates were present among Indigenous, residents in the rural Andes Mountains, underweight subjects, and those with a sedentary lifestyle. Muscle strength was significantly and directly correlated with mean 25(OH)D levels. After controlling for potential confounders, 25(OH)D deficiency prevalence rates were 31 and 43% higher among men and women with muscle weakness than those with normal strength, respectively.

CONCLUSIONS

One-third of older adults nationwide had evidence of muscle weakness. While the present study found a significant correlation between muscle strength and 25(OH)D concentrations, further research is needed to examine whether optimizing 25(OH)D levels may improve muscle weakness among older adults.

Association Between Serum Vitamin D and All-Cause and Cause-Specific Death in a General Japanese Population - The Hisayama Study

BACKGROUND

Few studies have investigated the association between serum vitamin D levels and mortality in general Asian populations.Methods and Results:We examined the association of serum 1,25-dihydroxyvitamin D (1,25(OH)₂D) levels with the risk of all-cause and cause-specific death in an average 9.5-year follow-up study of 3,292 community-dwelling Japanese subjects aged ≥40 years (2002-2012). The multivariable-adjusted hazard ratio (HR) for all-cause death increased significantly with lower serum 1,25(OH)₂D levels (HR 1.54 [95% confidence interval, 1.18-2.01] for the lowest quartile, 1.31 [0.99-1.73] for the 2nd quartile, 0.94 [0.70-1.25] for the 3rd quartile, 1.00 [Ref.] for highest quartile; P for trend <0.001). A similar association was observed for cardiovascular and respiratory infection death (both P for trend <0.01), but not for cancer death or death from other causes. In the stratified analysis, the association between lower serum 1,25(OH)₂D levels and the risk of respiratory infection death was stronger in subjects with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²than in those with eGFR ≥60 mL/min/1.73 m²; there was a significant heterogeneity in the association between eGFR levels (P for heterogeneity=0.04).

CONCLUSIONS

The findings suggested that a lower serum 1,25(OH)₂D level is a potential risk factor for all-cause death, especially cardiovascular and respiratory infection death, in the general Japanese population, and that lower serum 1,25(OH)₂D levels greatly increase the risk of respiratory infection death in subjects with kidney dysfunction.

25-Hydroxyvitamin D Status and Risk for Colorectal Cancer and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Epidemiological Studies

Epidemiological evidence suggests an association between low vitamin D status and risk for various outcomes including cardiovascular diseases, cancer, and type 2 diabetes mellitus (T2DM). Analyzing serum 25-hydroxyvitamin D [25(OH)D] is the most established means to evaluate an individual's vitamin D status. However, cutoff values for 25(OH)D insufficiency as well as for optimal 25(OH)D levels are controversial. This systematic review critically summarizes the epidemiological evidence regarding 25(OH)D levels and the risk for colorectal cancer and T2DM. The meta-analytical calculation revealed a pooled relative risk (RR) of 0.62 (CI 0.56-0.70; I² = 14.7%) for colorectal cancer and an RR of 0.66 (CI 0.61-0.73; I² = 38.6%) for T2DM when comparing individuals with the highest category of 25(OH)D with those in the lowest. A dose-response analysis showed an inverse association between 25(OH)D levels and RR for both outcomes up to concentrations of about 55 ng/mL for colorectal cancer and about 65 ng/mL for T2DM. At still higher 25(OH)D levels the RR increases slightly, consistent with a U-shaped association. In conclusion, a higher 25(OH)D status is associated with a lower risk for colorectal cancer and T2DM; however, this advantage is gradually lost as levels increase beyond 50-60 ng/mL.

Vitamin D and spinal cord injury: should we care?

STUDY DESIGN

Narrative review.

OBJECTIVES

This review provides an overview of the etiological factors and consequences of vitamin D insufficiency in relation to spinal cord injury (SCI) as well as important considerations for vitamin D supplementation.

SETTING

Montreal, Canada.

METHODS

Literature search.

RESULTS

Vitamin D insufficiency is common in SCI individuals owing to the presence of many contributing factors including limited sun exposure and intake, use of medication and endocrine perturbations. Although there are several biological plausible mechanisms by which vitamin D may act upon musculoskeletal and cardiometabolic health, the impact of vitamin D insufficiency on such systems remains ill defined in SCI. In the absence of guidelines for the management of vitamin D insufficiency in this high-risk population and in an attempt to provide clinical guidance, considerations for vitamin D supplementation such as the type of vitamin D, dosing regimens and toxicity are discussed and tentative recommendations suggested with particular reference to issues faced by SCI patients.

CONCLUSION

Although high rates of vitamin D insufficiency are encountered in SCI individuals, its consequences and the amount of vitamin D required to prevent insufficiency are still unknown, indicating a need for more intervention studies with well-defined outcome measures. Routine screening and monitoring of vitamin D as well as treatment of suboptimal status should be instituted in both acute and chronic setting. The close interactions between vitamin D and related bone minerals should be kept in mind when supplementing SCI individuals, and practices should be individualized with clinical conditions.

The association between serum 25-hydroxyvitamin D level and recurrent falls in the elderly population: a cohort study

Introduction

Serum vitamin D concentration is a major contributing factor for increasing the risk of fall and fall-related injuries in older adults. However, when prescribed and supplemented for these populations, the outcomes are controversial, and in several cases no improvement has been reported in reducing the risk of recurrent falls. This study aimed to examine the association between serum vitamin D concentration and recurrent falls in Iranian older adults.

Methods

This cohort study was conducted in the emergency departments of two university hospitals. A cohort of 82 elderly participants aged over 60 and suffered from an unintentional episode of falling was evaluated six months after their first ED visit. A structured, self-administered checklist was developed to obtain the participants’ demographic and clinical information. Participants also were asked about any recurrent fall experience during follow-up.

Results

The mean (SD) age of the study population was 75 (8). Over half of the participants were male (57.3%). The mean (median) serum 25-hydroxyvitamin D (25 (OH)D) concentration was 38 (34) ng/ml. Mean serum 25(OH)D levels varied slightly between gender groups (p=0.450). An inverse but insignificant association was found between the age of participants and their serum 25(OH)D levels (r=−0.03, p=0.7). A small but insignificant association also was found between the mean serum 25(OH)D level and the number of recurrent falls in elderly patients irrespective of their age, gender, or physical activity groups (OR=1.008, p=0.992).

Conclusion

In contrast to previous studies, no significant association of serum 25(OH)D concentration was found with recurrent falls in Iranian older adults.

Vitamin D deficiency, depression course and mortality: Longitudinal results from the Netherlands Study on Depression in Older persons (NESDO)

OBJECTIVE

To study the effect of vitamin D levels on depression course and remission status after two years, as well as attrition and mortality, in an older cohort.

METHODS

This study was part of the Netherlands Study on Depression in Older persons (NESDO), a prospective cohort study. 367 depressed older persons (≥ 60 years) were included. Baseline vitamin D status, reasons for loss to follow up, clinical depression diagnosis at two-year follow up, and six-monthly symptom scores were obtained. Data were analyzed by logistic regression and random coefficient models and adjusted for confounders of vitamin D status.

RESULTS

Vitamin D had no effect on the course of depression or remission, except for a trend towards lower remission rates in the severely deficient subgroup (25-(OH) vitamin D<25 nmol/l). Patients who died during follow up had significantly lower 25-(OH) vitamin D and 1,25-(OH)2 vitamin D levels than patients with continued participation.

CONCLUSIONS

For the total sample we found no effect of vitamin D levels on the course of depression or remission rates. However, we did find an effect of lower vitamin D levels on mortality. This strengthens the interpretation of vitamin D deficiency being a marker for poor somatic health status. The trend towards lower remission rates in the severely deficient subgroup raises the question whether this group could benefit from supplementation. Randomized controlled trials are necessary to study this.

Relation among 25(OH)D, Aquatic Exercises, and Multifunctional Fitness on Functional Performance of Elderly Women from the Community

OBJECTIVES

The aim of this study was to investigate if there is a relation among 25(OH)D, aquatic training, and multifunctional fitness on functional performance of elderly woman from the community.

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

We evaluated elderly women aged ≥ 60 years (67±5 years old). One-hundred eighty were engaged in aquatic training (AT), 119 in multifunctional fitness (MF) for at least one year, and sedentary group (SED) with 162 independent elderly women from the community centers who had not practicing any regular physical exercise at least one year before.

MEASUREMENTS

Timed up-and-go (TUG), 2-minute step test (2MST), 30-second chair stand (CS), arm curl (AC), functional reach test (FRT), unipedal balance test (UB) with visual control, handgrip right (HR) and handgrip left (HL) portable dynamometer for strength hip flexors (Hip strength) and knee extensors (Knee strength), serum 25(OH)D, intact parathyroid hormone (PTH), and creatinine clearance.

RESULTS

Physical and functional tests showed differences among the three groups (ST; TUG, CS, AC, FR and USB = p <0.001). The PTH and the TUG test correlated inversely with 25(OH)D (r = -0.29 - p <0.001/ r = - 0.16 - p <0.001), also between 25(OH)D and BMI for AT and MF groups respectively (r= -0,15; p=0,04/ r= - 0,19; p=0,036). The AC test showed positive correlation (r = 0, 1 - p <0.001). The age and 25(OH)D were controlled and assumed to be a covariates in the statistical analysis that employed ANCOVA. There was difference on the performance of TUG test (p= 0.049).

CONCLUSION

TUG performance was associated with age, exercise type and serum levels of 25(OH)D. The 25(OH)D insufficiency was common in elderly women from subtropical areas.

A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis

OBJECTIVES

The prevalence of knee osteoarthritis (OA) is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee OA pain and functional performance measures.

METHODS

The sample consisted of 256 (63% female) racially diverse (55% black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high-performance liquid chromatography. Participants provided self-report regarding knee OA pain and underwent a lower extremity functional performance test.

RESULTS

Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly less knee OA pain compared with participants with deficient or insufficient levels, regardless of obesity status. Furthermore, there was a significant interaction between obesity and 25(OH)D levels for lower extremity functional performance, such that obese individuals with adequate 25(OH)D levels demonstrated better performance than those obese participants with deficient or insufficient 25(OH)D levels.

DISCUSSION

The mechanisms by which adequate 25(OH)D levels are associated with pain severity and improved function have not been completely elucidated. It may be that the pleiotropic role of biologically active 25(OH)D influences pain and pain processing through peripheral and central mechanisms. Alternatively, higher levels of pain may lead to reduced outdoor activity, which may contribute to both obesity and decreased vitamin D. Thus, investigating vitamin D status in obese and nonobese individuals with knee OA warrants further study.

Depression and serum 25-hydroxyvitamin D in older adults living at northern latitudes - AGES-Reykjavik Study

Low vitamin D status may be associated with depression. Few studies have examined vitamin D and depression in older adults living at northern latitudes. The present study cross-sectionally investigated serum 25-hydroxyvitamin D (25(OH)D) status and depression among 5006 community-dwelling older persons (66-96 years) living in Iceland (latitudes 64-66°N). Depressive symptoms were measured by the fifteen-item Geriatric Depression Scale (GDS-15). Current major depressive disorder was assessed according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Serum 25(OH)D was analysed using chemiluminescence immunoassay and categorised into three groups: deficient (<30 nmol/l); inadequate (30-49·9 nmol/l); and adequate (≥50 nmol/l). There were twenty-eight (2 %) men and fifty (1 %) women with current major depressive disorder. Mean GDS-15 scores for men and women with adequate vitamin D concentrations were 2·1 and 2·2, respectively. Men and women with deficient v. adequate vitamin D status had more depressive symptoms (higher GDS-15 scores) (difference 0·7 (95 % CI 0·4, 0·9) and 0·4 (95 % CI 0·1, 0·6), respectively). Furthermore, men with deficient vitamin D status were more likely to have current major depressive disorder (adjusted OR 2·51; 95 % CI 1·03, 6·13) compared with men with adequate vitamin D status. Associations among women were not significant. In this older population living at northern latitudes, deficient vitamin D status may be associated with depression. Further investigations are warranted to evaluate the pathways that may be associated with risk of depression among older adults.

Mood disorders are associated with a more severe hypovitaminosis D than schizophrenia

Patients with psychiatric disorders display high levels of hypovitaminosis D (<50nmol/L). It remains unclear whether it is associated with specific diagnoses. To further explore vitamin D status in psychiatric inpatients, 82 individuals with mood disorders or schizophrenia/schizoaffective disorders were included. Hypovitaminosis D was significantly lower in patients with mood disorders than patients with schizophrenia (standardized β coefficient=0.385, p=0.007). Further studies are warranted to determine specific causes of hypovitaminosis D and the interest of supplementation.

Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty

Vitamin D is the main hormone of bone metabolism. However, the ubiquitary nature of vitamin D receptor (VDR) suggests potential for widespread effects, which has led to new research exploring the effects of vitamin D on a variety of tissues, especially in the skeletal muscle. In vitro studies have shown that the active form of vitamin D, calcitriol, acts in myocytes through genomic effects involving VDR activation in the cell nucleus to drive cellular differentiation and proliferation. A putative transmembrane receptor may be responsible for nongenomic effects leading to rapid influx of calcium within muscle cells. Hypovitaminosis D is consistently associated with decrease in muscle function and performance and increase in disability. On the contrary, vitamin D supplementation has been shown to improve muscle strength and gait in different settings, especially in elderly patients. Despite some controversies in the interpretation of meta-analysis, a reduced risk of falls has been attributed to vitamin D supplementation due to direct effects on muscle cells. Finally, a low vitamin D status is consistently associated with the frail phenotype. This is why many authorities recommend vitamin D supplementation in the frail patient.

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

BACKGROUND

Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population.

METHODS

In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists.

RESULTS

A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86-90) years. The median medicines taken during the month prior to admission was 10 (7-13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1).

CONCLUSIONS

Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.

Serum 25-Hydroxyvitamin D, Plasma Klotho, and Lower-Extremity Physical Performance Among Older Adults: Findings From the InCHIANTI Study

BACKGROUND

The hormone klotho is encoded by aging-suppressor gene klotho and has multiple roles, including regulating mineral (calcium and phosphate) homeostasis. Vitamin D also regulates mineral homeostasis and upregulates klotho expression. Klotho positively relates to longevity, upper-extremity strength, and reduced disability in older adults; however, it is unknown whether circulating klotho relates to lower-extremity physical performance or whether the relation of vitamin D with physical performance is mediated by klotho.

METHODS

Klotho and 25-hydroxyvitamin D [25(OH)D] were measured in 860 participants aged ≥ 55 years in Invecchiare in Chianti, "Aging in Chianti" (InCHIANTI), a prospective cohort study comprising Italian adults. Lower-extremity physical performance was measured using the Short Physical Performance Battery, a summary score of balance, chair stand ability, and walking speed. Weighted estimating equations related plasma klotho and serum 25(OH)D concentrations measured at one visit to Short Physical Performance Battery measured longitudinally at multiple visits.

RESULTS

Each additional natural log of klotho (pg/mL) was associated with 0.47 higher average Short Physical Performance Battery scores (95% confidence interval: 0.08 to 0.86, p value = .02) after adjustment for covariates, including 25(OH)D. Each natural log of 25(OH)D (ng/mL) was associated with 0.61 higher average Short Physical Performance Battery scores (95% confidence interval: 0.35 to 0.88, p value < .001) after adjustment for covariates, a result that changed little after adjustment for klotho.

CONCLUSIONS

Plasma klotho and 25(OH)D both positively related to lower-extremity physical performance. However, the findings did not support the hypothesis that klotho mediates the relation of 25(OH)D with physical performance.

Vitamin D Status among Older Adults Residing in the Littoral and Andes Mountains in Ecuador

OBJECTIVES

To estimate the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and its determinants among older adults in Ecuador.

METHODS

25(OH)D deficiency and insufficiency prevalence rates were examined among participants in the National Survey of Health, Wellbeing, and Aging. Logistic regression models were used to evaluate demographic characteristics associated with 25(OH)D deficiency.

RESULTS

Of 2,374 participants with a mean age of 71.0 (8.3) years, 25(OH)D insufficiency and deficiency were present in 67.8% (95% CI, 65.3-70.2) and 21.6% (95% CI, 19.5-23.7) of older adults in Ecuador, respectively. Women (OR, 3.19; 95% CI, 3.15-3.22), self-reported race as Indigenous (OR, 2.75; 95% CI, 2.70-2.80), and residents in rural (OR, 4.49; 95% CI, 4.40-4.58) and urban (OR, 2.74; 95% CI, 2.69-2.80) areas of the Andes Mountains region were variables significantly associated with 25(OH)D deficiency among older adults.

CONCLUSIONS

Despite abundant sunlight throughout the year in Ecuador, 25(OH)D deficiency was significantly prevalent among older women, Indigenous subjects, and subjects residing in the Andes Mountains region of the country. The present findings may assist public health authorities to implement policies of vitamin D supplementation among older adults at risk for this condition.

Vitamin D and muscle function in the elderly: the elixir of youth?

PURPOSE OF REVIEW

Circumstantial evidence suggests that vitamin D deficiency may contribute to age-related changes in skeletal muscle. This review discusses recent clinical trials examining effects of vitamin D on muscle function in the elderly, and poses the important question: can vitamin D reverse muscle ageing?

RECENT FINDINGS

Observational studies report an association between vitamin D and muscle atrophy/weakness in elderly subjects. Interventional studies suggest that frail, elderly subjects may benefit from vitamin D supplementation by displaying reduced falls, improved muscle function and increased muscle fibre size. However, meta-analyses do not report convincing effects of vitamin D in the elderly. This may be because of multiple factors including lack of standardized endpoints for muscle function, variable study design and different doses of vitamin D supplementation amongst these studies. The evidence base is therefore inconsistent.

SUMMARY

Vitamin D deficiency may exacerbate ageing of skeletal muscle. However, current evidence that vitamin D supplementation reverses age-related muscle dysfunction is equivocal and does not justify stringent vitamin D targets in the elderly. Until these issues are clarified, the safest option is to aim for conservative vitamin D targets that are sufficient for normal calcium homeostasis.

Serum 25-hydroxyvitamin d and the onset of late-life depressive mood in older men and women: the Pro.V.A. study

INTRODUCTION

Biological evidence suggests that vitamin D might be involved in regulating mood. The relationship between 25-hydroxyvitamin D (25OHD) and the onset of depressive symptoms was examined over a 4.4-year follow-up in a sample of older adults.

METHODS

This research was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study on a total of 1,039 women and 636 men aged 65 and older. Serum 25OHD levels were measured at baseline. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) at the baseline and during the follow-up. Analyses were adjusted for relevant confounders, including health and performance status.

RESULTS

25OHD levels correlated inversely with baseline GDS scores, but only in women. After controlling for confounders, women deficient in vitamin D (25OHD < 50 nmol/L) had higher GDS scores than those who were replete (25OHD > 75 nmol/L), with mean [SE] GDS scores: 9.57 [0.37] vs 8.31 [0.31], respectively, p = .02. In men, the relationship between 25OHD levels and baseline GDS scores was no longer significant after controlling for covariates. Adjusted hazard ratios and 95% confidence intervals for incident depression in participants who were vitamin D deficient vs replete were not statistically significant (hazard ratio: 0.74, 95% confidence interval [0.47-1.16] in women; hazard ratio: 0.96 95% confidence interval [0.45-2.06] in men).

CONCLUSION

Although an independent inverse association between 25OHD levels and GDS scores emerged for women on cross-sectional analysis, vitamin D deficiency showed no direct effect on the onset of late-life depressive symptoms in our prospectively studied population. Further studies are warranted to clarify the potential influence of vitamin D on psychological health.