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: 6.21).
12/2010; 95(12):5266-73. DOI: 10.1210/jc.2010-2317
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.
Available from: yi Wang
- "Studies examining the relationship between total circulating 25-hydroxyvitamin D [25(OH)D] levels and frailty have yielded mixed results. Many epidemiologic investigations have suggested that lower levels of 25(OH)D have been linked to muscle strength and increased risk of frailty [7–15]. Additionally, vitamin D supplementation reduces falls and improves muscle function in people with low 25(OH)D levels [16–18]. "
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ABSTRACT: Vitamin D binding protein (DBP) may alter the biologic activity of 25-hydroxyvitamin D [25(OH)D]. The objective of our present study was to determine the joint effect of serum 25(OH)D and DBP on the risk of frailty. Five hundred sixteen male participants aged 70 years or older were recruited in Changsha city and its surrounding area in Hunan province of China. Frailty was defined as the presence of at least three of the five following criteria: weakness, low physical activity, slow walking speed, exhaustion, and weight loss. Multivariate linear regression analysis was performed to assess the relationship between 25(OH)D and DBP levels. Odds ratios (ORs) for frailty were evaluated across quartiles of 25(OH)D and DBP levels, adjusted age, education, and body mass index. The results showed that participants in the lowest quartile of 25(OH)D and the highest quartile of DBP levels, the lowest quartile of 25(OH)D and the lowest quartile of DBP levels, and those in the the lower quartile of 25(OH)D and lowest quartile of DBP levels had significantly higher OR of being frail compared with those in the highest quartile of 25(OH)D and lowest quartile of DBP, with OR of 3.18 (95% CI: 1.46-4.56, P < 0.05), 2.63 (95% CI: 1.31-3.68, P < 0.01), and 2.52 (95% CI: 1.22-3.52, P < 0.05), respectively. The results indicate that the joint effect of serum 25(OH)D and DBP levels is associated with the risk of frailty, and serum DBP levels affects 25(OH)D-frailty relationship in the older men.
Available from: Kate L Lapane
- "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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Many of the symptoms, consequences, and risk factors for frailty are shared with late-life depression. However, thus far, few studies have addressed the conceptual and empirical interrelationships between these conditions. This review synthesizes existing studies that examined depression and frailty among older adults and provides suggestions for future research.MethodsA search was conducted using PubMed for publications through 2010. Reviewers assessed the eligibility of each report and abstracted information on study design, sample characteristics, and key findings, including how depression and frailty were conceptualized and treated in the analysis.ResultsOf 133 abstracted articles, 39 full-text publications met inclusion criteria. Overall, both cross-sectional (n = 16) and cohort studies (n = 23) indicate that frailty, its components, and functional impairment are risk factors for depression. Although cross-sectional studies indicate a positive association between depression and frailty, findings from cohort studies are less consistent. The majority of studies included only women and non-Hispanic Whites. None used diagnostic measures of depression or considered antidepressant use in the design or analysis of the studies.ConclusionsA number of empirical studies support for a bidirectional association between depression and frailty in later life. Extant studies have not adequately examined this relationship among men or racial/ethnic minorities, nor has the potential role of antidepressant medications been explored. An interdisciplinary approach to the study of geriatric syndromes such as late-life depression and frailty may promote cross-fertilization of ideas leading to novel conceptualization of intervention strategies to promote health and functioning in later life. Copyright © 2011 John Wiley & Sons, Ltd.
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ABSTRACT: De par ses conséquences et sa prévalence élevée, la fragilité peut être considérée comme un problème majeur chez le sujet âgé. Son origine est multifactorielle, compte tenu de la fréquence des déficits nutritionnels, leurs rôles quant à la survenue de la fragilité doivent être connus. Il est désormais bien établi que des apports protéiques et énergétiques insuffisants sont directement reliés à la fragilité par l’intermédiaire de plusieurs de ses composantes. Les données récentes soulignent aussi toute l’importance des micronutriments dont le déficit conduit à une fragilité indépendamment du rôle des macronutriments. Les données disponibles indiquent que les aspects qualitatifs doivent aussi être pris en compte dans l’alimentation des personnes âgées. Un suivi tenant compte de ces différents aspects apparaît un élément majeur dans la stratégie de prévention et de prise en charge de la fragilité.
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