Circulating 25-Hydroxyvitamin D Levels and Frailty Status in Older Women

Center for Chronic Disease Outcomes Research, VA Medical Center, and Department of Medicine, University of Minnesota, M.P.H., One Veterans Drive (111-0), Minneapolis, Minnesota 55417, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.31). 12/2010; 95(12):5266-73. DOI: 10.1210/jc.2010-2317
Source: PubMed

ABSTRACT Vitamin D deficiency and frailty are common with aging, but the association between these conditions is uncertain.
To determine the association between 25-hydroxyvitamin D (25(OH)D) levels and prevalent and incident frailty status among older women.
Cross-sectional and longitudinal analyses of a prospective cohort study.
Four U.S. centers.
6307 women aged≥69 years.
Frailty status classified as robust, intermediate stage, or frail at baseline; and robust, intermediate stage, frail, or dead (all-cause mortality) at follow-up an average of 4.5 years later.
At baseline, there was a U-shaped association between 25(OH)D level and odds of frailty with the lowest risk among women with levels 20.0-29.9 ng/ml (referent group). Compared with this group, the odds of frailty were higher among those with levels<15.0 ng/ml [multivariable odds ratio (MOR) 1.47, 95% confidence interval (CI), 1.19-1.82], those with levels 15.0-19.9 ng/ml (MOR 1.24, 95% CI 0.99-1.54), and those with levels≥30 ng/ml (MOR 1.32, 95% CI 1.06-1.63). Among 4551 nonfrail women at baseline, the odds of frailty/death (vs. robust/intermediate) at follow-up appeared higher among those with levels 15.0-19.9 ng/ml (MOR 1.21, 95% CI 0.99-1.49), but the CI overlapped 1.0. The odds of death (vs. robust/intermediate/frail at follow-up) was higher among those with levels<15.0 ng/ml (MOR 1.40, 95% CI 1.04-1.88) and those with levels 15.0-19.9 ng/ml (MOR 1.30, 95% CI 0.97-1.75), although the latter association did not quite reach significance.
Lower (<20 ng/ml) and higher (≥30 ng/ml) levels of 25(OH)D among older women were moderately associated with a higher odds of frailty at baseline. Among nonfrail women at baseline, lower levels (<20 ng/ml) were modestly associated with an increased risk of incident frailty or death at follow-up.

    • "The study suggested a reverse J-shaped association between serum level of 25(OH)D and mortality, whereby a serum 25(OH)D level of 50-60 nmol/L was associated with the lowest mortality risk [88]. However, other authors have suggested these data could be an artifact of including people who started supplementing with vitamin D in later life, to reduce the risk of osteoporotic fractures [99] [100]. Indeed, a meta-analysis of 32 studies failed to confirm this pattern [101]. "
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    ABSTRACT: With the endogenous formation of vitamin D being significantly curtailed because of public awareness of skin cancer dangers, attention is turning to dietary sources. Cumulative evidence has implicated vitamin D deficiency in increasing susceptibility to various gastrointestinal disorders, including colorectal cancer, inflammatory bowel diseases, diverticulitis and irritable bowel syndrome. There is also reason to suggest adjunct vitamin D therapy for such diseases. Although there is justification for increasing vitamin D intake overall, optimal intakes will vary among individuals. Genomic technologies have revealed several hundreds of genes associated with vitamin D actions. The nature of these genes emphasizes the potentially negative implications of modulating vitamin D intakes in the absence of complementary human genetic and genomic data, including information on the gut microbiome. However, we are not yet in a position to apply this information. Genomic data (transcriptomics, metabolomics, proteomics and metagenomics) could provide evidence that vitamin D sufficiency has been achieved. We suggest that there is an increasingly strong case for considering the more widespread use of vitamin D fortified foods and/and dietary supplements to benefit gastrointestinal health. However, intake levels might beneficially be informed by personalized genetic and genomic information, for optimal disease prevention and maintenance of remission. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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    • "physical (i.e., balance), nutritive (i.e., weight loss), cognitive (i.e., memory impairments), and sensory (i.e., vision loss) domains; and the biological syndrome model (Fried et al., 2001), in which frailty is modeled as syndrome characterized by weight loss, exhaustion, inactivity, slowness, and weakness (Fried et al., 2001), akin to geriatric failure-to-thrive (Committee on a National Research Agenda on Aging, 1991). Frailty has also been linked to sacropenia (Frisoli et al., 2011), vitamin D deficiency (Ensrud et al., 2010), and related health conditions. Depending on the index used, the prevalence of frailty among adults 65 years and older is estimated to be 10.9%–20.3% "
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