Association of low serum 25-hydroxyvitamin D levels with the frailty syndrome in Mexican community-dwelling elderly

Effect of Continuous Positive Airway Pressure on Incident Frailty in Elderly Patients with Obstructive Sleep Apnea: A Study Based on Propensity Score Matching

Background

The concomitant rise in the prevalence of obstructive sleep apnea (OSA) and frailty among the elderly population has been linked to an increase in mortality rates. Despite continuous positive airway pressure (CPAP) being the gold standard treatment for OSA, its impact on incident frailty remains inadequately explored.

Methods

In this cohort study, we analyzed data from 1290 patients diagnosed with OSA, aged 60 years and older. A subset of 71 patients who demonstrated high adherence to CPAP therapy were categorized as the CPAP group. Propensity score matching (PSM) was employed at a 1:4 ratio, matching for variables such as age, gender, body mass index (BMI), and sleep apnea-hypopnea index (AHI), to establish a non-CPAP group for comparison. The FRAIL scale was utilized to evaluate the frailty status of participants. Logistic regression analysis examined the relationship between CPAP therapy and incident frailty, as well as its individual components, in elderly patients with OSA.

Results

During a median follow-up period of 52 months, incident frailty was observed in 70 patients (19.7%). Patients with OSA receiving CPAP therapy exhibited a lower incidence of frailty compared to those not receiving CPAP (11.26% vs 21.83%, P=0.045). In the multivariate model, CPAP therapy was significantly correlated with a reduced risk of incident frailty (OR = 0.36, 95% CI, 0.15-0.88; P = 0.025). Subcomponent analyses revealed that CPAP was associated with a lower risk of fatigue (OR=0.35, 95% CI, 0.19-0.63; P < 0.001), resistance (OR = 0.32, 95% CI, 0.14-0.74; P=0.008), and weight loss (OR = 0.38, 95% CI, 0.19-0.75; P = 0.007).

Conclusion

CPAP therapy was associated with a reduced risk of incident frailty among elderly patients with OSA.

Effects of Vitamin D Supplementation on Testosterone, Prostate, and Lower Urinary Tract Symptoms: A Prospective, Comparative Study

PURPOSE

Several studies have associated the serum vitamin D level with total testosterone levels and the prostate volume. Herein, we investigated the effect of vitamin D supplementation on testosterone, prostate, and lower urinary tract symptoms (LUTS) in men.

MATERIALS AND METHODS

Men over 40 years of age diagnosed with a vitamin D deficiency (25[OH]D <20 ng/mL) who received vitamin D supplementation for one year were included in the study and administered 25,000 IU of cholecalciferol every 2 weeks. Prostate ultrasound, uroflowmetry, postvoid residual urine volume measurement, and serological tests (serum testosterone levels, etc.) were performed upon diagnosis and one year later. Participants also answered the International Prostate Symptom Score (IPSS) and Aging Males' Symptoms Scale (AMS) questionnaires.

RESULTS

A significant increase was observed in the vitamin D level following one year of vitamin D supplementation, with a significant decrease in the postvoid residual urine volume, total IPSS score and without a significant change in the prostate volume. Improved psychological subscale score of AMS questionnaire was observed with a statistical significance.

CONCLUSIONS

Vitamin D supplementation suppressed the increase in the prostate volume and improved the LUTS. Although there is no direct effect on serum testosterone levels, vitamin D supplementation helped improve hypogonadal symptoms.

Serum vitamin D levels and mortality in Mexicans: results from the Mexican Health and Aging Study

Introduction

Background: the population in Latin America is aging and elders face several obstacles for good health, including an elevated frequency of vitamin D deficiency. Thus, identification of patients at high risk to develop its negative consequences should be a priority. Objective: the objective of this analysis was to determine if levels of vitamin D lower than 15 ng/ml are associated with high mortality in Mexican elderly population, from the database of the Mexican Health and Aging Study (MHAS). Methods: prospective, population study in Mexico, that included Subjects of 50 years and older who were evaluated for Serum vitamin D levels during the year 2012 (third wave of the study). Serum 25(OH)D levels were categorized into four groups, based on cutoff points used in previous studies on vitamin D and frailty: < 15, 15-< 20, 20-< 30 and ≥ 30 ng/ml. Mortality was evaluated during 2015 (fourth wave of the study). Hazard ratio was calculated (for mortality) through Cox Regression Model, adjusted for covariates. Results: we included 1626 participants, and those with lower levels of vitamin D were older, more often women, required more aid for activities of daily living, reported higher number of chronic diseases, and lower scores on cognition. The relative risk of death was 5.421 (95 % CI 2.465-11.92, p < 0.001) for the participants with vitamin D levels < 15, which after adjusting for covariates, remained statistically significant. Conclusions: levels of vitamin D lower of 15, are associated with an increase in the rate of mortality in community-dwelling senior Mexicans.

Current Evidence on the Association of Micronutrient Malnutrition with Mild Cognitive Impairment, Frailty, and Cognitive Frailty among Older Adults: A Scoping Review

Micronutrient malnutrition is thought to play an important role in the cause of cognitive impairment and physical frailty. The purpose of this scoping review was to map current evidence on the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults. The scoping review was conducted based on the 2005 methodological framework by Arksey and O'Malley. The search strategy for potential literature on micronutrient concentration in blood and cognitive frailty was retrieved based on the keywords using electronic databases (PubMed, Cochrane Library, Google Scholar, Ovid, and Science Direct) from January 2010 to December 2021. Gray literature was also included in the searches. A total of 4310 articles were retrieved and 43 articles were incorporated in the review. Findings revealed a trend of significant association between low levels of B vitamins (folate and vitamin B12), vitamin D, vitamin A, vitamin E, omega 3 fatty acid, and albumin, and high homocysteine levels in blood with an increased risk of mild cognitive impairment among older adults. The results also indicated that low vitamin D levels, albumin, and antioxidants (lutein and zeaxanthin) in blood were significantly associated with frailty among older adults, while β-cryptoxanthin and zeaxanthin in blood were inversely associated with the risk of cognitive frailty. Vitamin D and antioxidants seemed to be targeted nutrients for the prevention of cognitive frailty. In conclusion, a wide range of micronutrient deficiency was associated with either mild cognitive impairment or frailty; however, little evidence exists on the dual impairment, i.e., cognitive frailty. This scoping review can serve as preliminary evidence for the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults and prove the relevancy of the topic for future systematic reviews.

Functional hypogonadism among patients with obesity, diabetes, and metabolic syndrome

Testosterone deficiency, defined as low total testosterone combined with physical, cognitive, and sexual signs and/or symptoms, is a common finding in adult men. Functional hypogonadism (FH) is defined as borderline low testosterone (T) secondary to aging and/or comorbid conditions such as diabetes, obesity, and/or metabolic syndrome. The relationship between FH and metabolic disorders is multifactorial and bidirectional, and associated with a disruption of the hypothalamic-pituitary-gonadal axis. Resolution of FH requires the correct diagnosis and treatment of the underlying condition(s) with lifestyle modifications considered first-line therapy. Normalization of T levels through dietary modifications such as caloric restriction and restructuring of macronutrients have recently been explored. Exercise and sleep quality have been associated with T levels, and patients should be encouraged to practice resistance training and sleep seven to nine hours per night. Supplementation with vitamin D and Trigonella foenum-graecum may also be considered when optimizing T levels. Ultimately, treatment of FH requires a multidisciplinary approach and personalized patient care.

The role of vitamin D in the link between physical frailty and cognitive function: A mediation analysis in community-dwelling Chinese older adults

Background

Physical frailty and cognitive aging have important influences on poor clinical outcomes in older adults. Many studies have investigated the association between frailty and cognitive function, but whether vitamin D mediates the association between frailty and cognitive function is unclear. We explored the mediating role of vitamin D on the cross-sectional association between physical frailty and cognitive function using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Methods

We analyzed data from 1944 subjects aged 60 years and older from the 2011 CLHLS cohort. Frailty status was identified by the Osteoporotic Fracture Study (SOF) index. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. Linear regression models were used to examine the association between frailty, vitamin D, and cognition, adjusted for a range of covariates. Mediation analyses tested the indirect effects of vitamin D on physical frailty and cognitive function.

Result

Physical frailty was negatively associated with vitamin D levels and scores on the MMSE, and vitamin D levels were positively associated with scores on the MMSE. Linear regression analysis showed that physical frailty and serum vitamin D concentration were significant predictors of cognitive function. Importantly, mediation analysis showed that serum vitamin D concentration significantly mediated the relationship between physical frailty and cognitive function.

Conclusion

The association between physical frailty and cognitive function appears to be mediated by vitamin D. Future studies should explore whether serum vitamin D concentrations may mediate the association between physical frailty and cognitive decline and whether this mediating role is moderated by other factors.

Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

Introduction:

Vitamin D (VD) deficiency is a major public health problem worldwide. In spite of its high prevalence, particularly among elderly people, VD deficiency is still underestimated by many physicians. Increasingly, VD deficiency is associated with several known geriatric syndromes.

Methods:

The study sample consisted of 125 patients, aged 75 years and older, admitted to the acute geriatric unit. The plausible association between the serum 25-hydroxyvitamin D [25(OH)D] level and patient age, sex, body mass index, renal function, cholecystectomy history, and the prescribed drugs had been investigated. The Fisher's exact test was used to conduct the statistical analysis of data.

Results:

Surprisingly, furosemide treatment was correlated with normal 25(OH)D levels and an increased incidence of secondary hyperparathyroidism. Unlike the other four parameters mentioned above, our data showed that only the patient sex exhibited a significant association with 25(OH)D level as elderly males suffered from a serious VD deficiency as compared to elderly females.

Conclusion:

Old age is an independent risk factor for VD deficiency. The supplementary dose of VD should be precisely defined to achieve the optimal serum 25(OH)D level in elderly people. The definition of the normal serum 25(OH)D threshold in elderly furosemide-treated patients is worth of further studies.

Pinpointing a Role for Vitamin D in Frailty: A Time for Animal Models?

Frailty is a condition marked by greater susceptibility to adverse outcomes, including disability and mortality, which affects up to 50% of those 80 years of age and older. Concurrently, serum vitamin D insufficiency and deficiency, for which as many as 70% of older adults may be at risk, potentially play an important role in frailty onset and progression. Large population driven studies have uncovered associations between low serum vitamin D levels and higher incidence of frailty. However, attempts to apply vitamin D therapeutically to treat and/or prevent frailty have not yielded consistent support for benefits. Given the complexity and inconsistency arising from human studies involving vitamin D, our research group has recently published on animal models of vitamin D insufficiency. Combining our model with the emerging development of animal frailty assessment, we identified that higher than standard levels of vitamin D supplementation may delay frailty in mice. In this viewpoint article, we will discuss current knowledge regarding the importance of vitamin D in frailty progression, the emerging significance of animal models in addressing these relationships, and the future for pre-clinical and clinical research.

25-Hydroxy cholecalciferol, anti-Müllerian hormone, and thyroid profiles among infertile men

BACKGROUND AND AIM

We examined the relationship among vit.D₃, AMH, FT3, FT4, and TSH, in addition to the serum levels of reproductive hormones (FSH, LH, prolactin, and free testosterone), in oligoasthenoteratozoospermia and azoospermia patients in a cohort of infertile men from Egypt to establish a clinical marker/cause-effect relationship.

METHODS

This cross-sectional cohort study was carried out on 301 men (105 males with oligoasthenoteratozoospermia and 96 males with azoospermia), in addition to 100 controls. Measurements of serum vit.D₃, AMH, FT3, FT4, and TSH levels, in addition to reproductive hormone assays, were performed on all included subjects, using ELISA kits.

RESULTS

Overall, results showed significantly lower serum levels of vit.D₃ in infertile men than in the controls, with a greater decrease observed in men with azoospermia than in oligoasthenoteratozoospermia patients, (p < .05 for all). Significantly higher serum TSH and FSH levels and significantly lower serum free testosterone levels were observed in males with azoospermia than in males with oligoasthenoteratozoospermia and the controls (p < .05 for both). There were no significant differences between the studied groups in terms of AMH, FT3 or FT4 levels. LH levels were negatively correlated with TSH levels and positively correlated with AMH levels among men with oligoasthenoteratozoospermia, while among men with azoospermia, LH levels were positively correlated with vit.D₃ levels (p < .05 for all).

CONCLUSION

Decreased Vit.D₃ could play a role in male infertility, in addition to abnormal thyroid function, which needs further investigation.

Low Vitamin D Levels and Frailty Status in Older Adults: A Systematic Review and Meta-Analysis

Serum vitamin D deficiency is widespread among older adults and is a potential modifiable risk factor for frailty. Moreover, frailty has been suggested as an intermediate step in the association between low levels of vitamin D and mortality. Hence, we conducted a systematic review of the literature and meta-analysis to test the possible association of low concentrations of serum 25-hydroxyvitamin D (25(OH)D), a marker of vitamin D status, with frailty in later life. We reviewed cross-sectional or longitudinal studies evaluating populations of older adults and identifying frailty by a currently validated scale. Meta-analyses were restricted to cross-sectional data from studies using Fried’s phenotype to identify frailty. Twenty-six studies were considered in the qualitative synthesis, and thirteen studies were included in the meta-analyses. Quantitative analyses showed significant differences in the comparisons of frail (standardized mean difference (SMD)—1.31, 95% confidence interval (CI) (−2.47, −0.15), p = 0.0271) and pre-frail (SMD—0.79, 95% CI (−1.58, −0.003), p = 0.0491) subjects vs. non-frail subjects. Sensitivity analyses reduced heterogeneity, resulting in a smaller but still highly significant between-groups difference. Results obtained indicate that lower 25(OH)D levels are significantly associated with increasing frailty severity. Future challenges include interventional studies testing the possible benefits of vitamin D supplementation in older adults to prevent/palliate frailty and its associated outcomes.

Plasma 25-hydroxyvitamin D level and the risk of frailty among Chinese community-based oldest-old: evidence from the CLHLS study

Background

Vitamin D deficiency has been linked to the risk of frailty. However, there are limited methods for evaluations of the potential association of vitamin D with frailty in a longevous (80+) population. The aim of this study was to examine the association between plasma 25-hydroxyvitamin D [25(OH)D] levels and the risk of frailty among the Chinese community based oldest-old.

Methods

Secondary analysis of data compiled in the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 1324) was performed. Frailty was assessed by the Study of Osteoporotic Fractures (SOF) index. Multivariate logistic regression and spline smoothing with threshold effect analysis were performed to investigate the association between 25(OH) D level and the risk of frailty after adjusting for socio-demographic variables, health characteristics and confounding biomarkers.

Results

The mean age was 92.89 ± 7.92 years, and 844 (63.7%) participants were women. In all, data from 426 (33.2, 95% confidence interval, CI: 29.66–34.69) frail participants were recorded. After adjustment for confounding covariates, the level of 25(OH) D was significantly related to frailty. By spline smoothing with threshold effect analysis, a monotonically negative association between 25(OH) D and frailty was identified. Subgroup analyses revealed that the association did not differ by sex or age.

Conclusions

The 25(OH) D level was inversely associated with the risk of frailty among the Chinese community-based oldest-old.

The inter-relationship between marginal vitamin D deficiency and muscle

PURPOSE OF REVIEW

We review the recent literature on the interplay between mild vitamin D deficiency and skeletal muscle strength and performance.

RECENT FINDINGS

Preclinical studies indicate that vitamin D is important in muscle proliferation, differentiation and mitochondrial function, whereas some epidemiological studies demonstrate associations with muscle strength and low physical performance. Recent studies have implicated vitamin D deficiency in the development of frailty and sarcopenia in the older population. Some small studies have assessed its impact on muscle function in special circumstances such as elite sport and critical illness. Advances in liquid chromatography/mass spectrometry technologies have allowed the inter-relationships between the vitamin D metabolome and muscle phenotype to be characterized. There is evidence of distinct effects on human skeletal muscle gene expression between vitamin D metabolites.

SUMMARY

Large-scale clinical trials with well defined cohorts and outcomes are needed to provide clinically meaningful insights into this area. Care should be taken to stratify participants by vitamin D status at baseline and over follow-up in addition to observing a range of measures of muscle function.

Individual and cumulative association of commonly used biomarkers on frailty: a cross-sectional analysis of the Mexican Health and Aging Study

Frailty has been recognized as a common condition in older adults, however, there is scarce information on the association between frailty and commonly used biomarkers. The aim of this study was to assess the individual and cumulative association of biomarkers with frailty status. This is a cross-sectional analysis of the 2012 wave of the Mexican Health and Aging Study. A sub-sample of 60-year or older adults with anthropometric measurements was analyzed. Frailty was defined with a 31-item frailty index and those considered frail had a score ≥ 0.21. Biomarkers were further categorized as normal/abnormal and tested both one by one and grouped (according to their usual cutoff values). Adjusted logistic models were performed. A total of 1128 older adults were analyzed and their mean age was 69.45 years and 51.24% of them were women. 26.7% (n = 301) were categorized as frail. Individual biomarkers associated with frailty after adjusting for confounding were: hemoglobin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.13-2.46, p = 0.009], glycated hemoglobin (OR 2.04, 95% CI 1.54-2.7, p < 0.001) and vitamin D (OR 1.53, 95% CI 1.13-2.07, p = 0.005). Those with ≥ 4 abnormal biomarkers had an independent association with frailty when compared to those without any abnormal biomarker (OR 2.64, 95% CI 1.3-5.25, p = 0.005). Aside from the individual associations of specific biomarkers, our findings show that an incremental association of abnormal biomarkers increases the probability of frailty, accounting for the multidimensional nature of frailty and the possible interplay between components of the system that potentiate to give rise to a negative condition such as frailty.

Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample

The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9 years). The Edmonton Frailty Scale was administered during the patient's admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach's alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r = 0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p < 0.05). The socio-clinical analysis, showed statistically significant differences in the age of respondents, educational attainment, occupational activity, number of drugs taken and co-occurrence of chronic diseases. A higher values of the Edmonton Frailty Scale were indicated for individuals >70 years than for those <70 years (p < 0.001). The Edmonton Frailty Scale proved to be a reliable tool which may be used in the Polish population. The use of this questionnaire for frailty syndrome may be helpful in everyday clinical practice.

Association of vitamin D status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems in patients with type 2 diabetes mellitus

OBJECTIVE

The aim of the present study was to evaluate the relationship between vitamin D (25[OH]D) status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems such as QRISK2, BNF, ASSING, SCORE, and Framingham in patients with type 2 diabetes mellitus(T2DM).

METHODS

The study included 108 patients with vitamin D insufficiency (25[OH]D ≥ 10-30 ng/mL) and 100 patients with vitamin D deficiency (25[OH]D < 10 ng/mL), who were admitted to the diabetes outpatient clinics due to T2DM and who were aged 45-65 years. QRISK2, BNF, ASSING, SCORE, and Framingham were calculated and compared between the two groups.

RESULTS

HbA1c levels were significantly higher in patients with vitamin D deficiency. Patients with vitamin D deficiency had significantly higher Framingham risk score (p < .001) and significantly lower BNF score (p < .001), whereas other scores did not significantly differ between the groups. There was a moderate, statistically significant correlation between 25[OH]D levels and Framingham risk score in negative direction (r = 0.537) and a weak but statistically significant correlation between 25[OH]D levels and BNF score (r = 0.295). 25[OH]D levels were significantly higher and HbA1c levels were significantly lower in patients with Framingham cardiovascular risk score ≤10%.

CONCLUSION

We found a close relationship with Framingham cardiovascular risk score in diabetic patients with very low serum vitamin D levels. Cardiovascular risk as assessed by the Framingham's scale increases with decreasing 25[OH]D levels. BNF score was negatively correlated with 25[OH]D levels.

Patterns of circulating fat-soluble vitamins and carotenoids and risk of frailty in four European cohorts of older adults

PURPOSE

To investigate the cross-sectional and prospective associations between patterns of serum fat-soluble micronutrients and frailty in four European cohorts of older adults 65 years of age and older.

METHODS

Participants from the Three-City (Bordeaux, France), AMI (Gironde, France), TSHA (Toledo, Spain) and InCHIANTI (Tuscany, Italy) cohorts with available data on serum α-carotene, β-carotene, lycopene, cryptoxanthin, lutein + zeaxanthin, retinol, α-tocopherol, γ-tocopherol and 25-hydroxyvitamin D3 (25(OH)D) were included. A principal component (PC) analysis was used to derive micronutrient patterns. Frailty was defined using Fried's criteria. Multivariate logistic regression models adjusted for socio-demographic and health-related covariates were performed to assess the association between micronutrient patterns and prevalent frailty in 1324 participants, and the risk of frailty in 915 initially non-frail participants.

RESULTS

Three different patterns were identified: the first pattern was characterized by higher serum carotenoids and α-tocopherol levels; the second was characterized by high loadings for serum vitamins A and E levels and low loadings for carotenes level; the third one had the highest loading for serum 25(OH)D and cryptoxanthin level and the lowest loading for vitamin A and E. A significant cross-sectional association was only observed between the seconnd PC and prevalent frailty (p = 0.02). Compared to the highest quartile, participants in the lowest quartile-i.e., high carotenes and low vitamins E and A levels-had higher odds of frailty (Odds ratio = 2.2; 95% confidence interval 1.3-3.8). No association with the risk of frailty was observed.

CONCLUSIONS

These findings suggest that some specific micronutrient patterns are markers but not predictors of frailty in these European cohorts of older adults.

Frailty and the endocrine system

Frailty is a condition characterised by loss of biological reserves, failure of homoeostatic mechanisms, and vulnerability to adverse outcomes. The endocrine system is considered particularly important in frailty, because of its complex inter-relationships with the brain, immune system, and skeletal muscle. This Review summarises evidence indicating a key role for the hypothalamic-pituitary axis in the pathogenesis of frailty through aberrant regulation of glucocorticoid secretion, insulin-like growth factor signalling, and androgen production. Evidence also indicates a potential role for vitamin D and insulin resistance in the pathogenesis of frailty. The role of thyroid hormones in the pathogenesis of frailty remains uncertain. Key convergent pathological effects of frailty include loss of muscle mass and strength, with consequent impact on mobility and activities of daily living. Future translational research should focus on the understanding of endocrine mechanisms, to identify potential biomarkers of the condition, modifiable targets for treatment, and novel pharmacological drugs targeted at the endocrine components of frailty.

Dietary intake and adequacy of energy and nutrients in Mexican older adults: results from two National Health and Nutrition Surveys

Objective:

To describe energy and nutrient intakes and their adequacies in older Mexican adults participating in the National Health and Nutrition Survey (Ensanut) 2006 and 2012.

Materials and methods:

Dietary information was obtained through a semiquantitative food frequency questionnaire (SFFQ) from 526 adults 60 y and older participating in Ensanut 2012 and 3 326 in Ensanut 2006 in Mexico. Quantile and logistic regression models were used to obtain medians and marginal effects of each nutrient, adjusting by confounders and survey design.

Results:

Dietary intake of energy and nutrients was similar in both surveys. Most common micronutrients at risk of dietary deficiency were, for vitamins: A, B-12, C, D and folate, and for minerals: calcium, iron and zinc, in both surveys. Excessive intake of sugar and saturated fat and low fiber intake were common.

Conclusions:

Diet in older Mexican adults is low in micronutrient essentials, and excessive in fat and sugar. Attention to the diet in this age group through targeted interventions is necessary to promote a healthy diet.

Impact of metabolic status on the association of serum vitamin D with hypogonadism and lower urinary tract symptoms/benign prostatic hyperplasia

OBJECTIVE

The objective of this study is to investigate the impact of metabolic status on associations of serum vitamin D with hypogonadism and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

A total of 612 men underwent physical examination, biochemical/hormonal blood testing, and transrectal prostate ultrasound. Moreover, the subjects filled out standard questionnaires for identification and grading of LUTS and hypogonadism symptoms. Parameters were statistically compared with independent t-tests and correlation analyses.

RESULTS

Vitamin D levels positively correlated with total testosterone (TT) but not with prostate volume or International Prostate Symptom Score (IPSS). Patients with metabolic syndrome had significantly lower vitamin D levels, which were not correlated with TT, prostate volume, or IPSS. However, vitamin D was positively correlated with TT, and negatively correlated with prostate volume and quality-of-life IPSS in subjects without metabolic syndrome.

CONCLUSION

The clinical usefulness of vitamin D for treatment of hypogonadism or LUTS/BPH varies according to metabolic status.

Association of the modified frailty index with adverse outcomes after penile prosthesis implantation

OBJECTIVES

To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation.

MATERIAL AND METHODS

A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients' and procedure's risk factors.

RESULTS

Mean age was 64.9 ± 5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p = 0.031) and associated Peyronie's disease (PD) (p = 0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p < 0.05). Only PD and HbA1c sustained an independent significant impact.

CONCLUSIONS

mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.