Abstract
BACKGROUND/OBJECTIVES:
Although both frailty and low vitamin D have been separately associated with an increased risk for adverse health, their joined effects on mortality have not been reported. The current study examined prospectively the effects of frailty and vitamin D status on mortality in US older adults.
SUBJECTS/METHODS:
Participants aged ⩾60 years in The Third National Health and Nutrition Examination Survey with 12 years of mortality follow-up were included in the analysis (n=4731). Frailty was defined as meeting three or more criteria and pre-frailty as meeting one or two of the five frailty criteria (low body mass index (BMI), slow walking, weakness, exhaustion and low physical activity). Vitamin D status was assessed by serum 25-hydroxyvitamin D (25(OH)D) and categorized into quartiles. Analyses were adjusted for gender, race, age, smoking, education, latitude and other comorbid conditions.
RESULTS:
Serum 25(OH)D concentrations were lowest in participants with frailty, intermediate in participants with pre-frailty and highest in participants without frailty. The odds of frailty in the lowest quartile of serum 25(OH)D was 1.94 times the odds in the highest quartile (95% confidence interval (CI): 1.09–3.44). Mortality was positively associated with frailty, with the risk among participants who were frail and had low serum 25(OH)D being significantly higher than those who were not frail and who had high concentrations of serum 25(OH)D (hazards ratio 2.98; 95% CI: 2.01–4.42).
CONCLUSION:
Our results suggest that low serum 25(OH)D is associated with frailty, and there is additive joint effects of serum 25(OH)D and frailty on all-cause mortality in older adults.
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References
Inouye SK, Studenski S, Tinetti ME, Kuchel GA . Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780–791.
Shardell M, Hicks GE, Miller RR, Kritchevsky S, Andersen D, Bandinelli S et al. Association of low vitamin D levels with the frailty syndrome in men and women. J Gerontol A Biol Sci Med Sci 2009; 64: 69–75.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156.
Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005; 53: 1321–1330.
Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE . Race/ethnicity social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Prev Med 2000; 18: 46–53.
Vincent G, Velkoff V In: US Department of Commerce (ed) The Next Four Decades: The Older Population in the United States: 2010 to 2050. US Census Bureau: Washington, DC, 2010 pp 25–1128.
Adams JS, Hewison M . Update in vitamin D. J Clin Endocrinol Metab 2010; 95: 471–478.
Cherniack EP, Florez HJ, Troen BR . Emerging therapies to treat frailty syndrome in the elderly. Altern Med Rev 2007; 12: 246–258.
Looker AC, Mussolino ME Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults J Bone Miner Res 2008; 23: 143–150.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2010; 96: 53–58.
Prabhala A, Garg R, Dandona P . Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med 2000; 160: 1199–1203.
Rimaniol JM, Authier FJ, Chariot P . Muscle weakness in intensive care patients: initial manifestation of vitamin D deficiency. Intensive Care Med 1994; 20: 591–592.
Bischoff HA, Stahelin HB, Urscheler N, Ehrsam R, Vonthein R, Perrig-Chiello P et al. Muscle strength in the elderly: its relation to vitamin D metabolites. Arch Phys Med Rehabil 1999; 80: 54–58.
Houston DK, Cesari M, Ferrucci L, Cherubini A, Maggio D, Bartali B et al. Association between vitamin D status and physical performance: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2007; 62: 440–446.
Mets T . Calcium, vitamin D, and hip fractures. Incidence of falls may have decreased. BMJ 1994; 309: 193.
Wilhelm-Leen ER, Hall YN, Deboer IH, Chertow GM . Vitamin D deficiency and frailty in older Americans. J Intern Med 2010; 268: 171–180.
Chang CI, Chan DC, Kuo KN, Hsiung CA, Chen CY . Vitamin D insufficiency and frailty syndrome in older adults living in a Northern Taiwan community. Arch gerontol geriatr 2010; 50 (Suppl 1): S17–S21.
Yu P, Song X, Shi J, Mitnitski A, Tang Z, Fang X et al. Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing Longitudinal Study of Aging. Arch Gerontol Geriatr 2012; 54: 3–8.
Jacobs JM, Cohen A, Ein-Mor E, Maaravi Y, Stessman J . Frailty cognitive impairment and mortality among the oldest old. J Nutr Health Aging 2011; 15: 678–682.
Rockwood K, Song X, Mitnitski A . Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey. CMAJ 2011; 183: E487–E494.
The Third National Health and Examination Survey Reference Manuals and Reports., National Center for Health Statistics: Hyattsville, MD, 1996 (CD-rom).
Graham JE, Snih SA, Berges IM, Ray LA, Markides KS, Ottenbacher KJ . Frailty and 10-year mortality in community-living Mexican American older adults. Gerontology 2009; 55: 644–651.
Ahmed N, Mandel R, Fain MJ . Frailty: an emerging geriatric syndrome. Am J Med 2007; 120: 748–753.
Puts MT, Visser M, Twisk JW, Deeg DJ, Lips P . Endocrine and inflammatory markers as predictors of frailty. Clin Endocrinol 2005; 63: 403–411.
Wilhelm-Leen ER, Hall YN, M KT, Chertow GM . Frailty and chronic kidney disease: the Third National Health and Nutrition Evaluation Survey. Am J Med 2009; 122: 664–671. e2.
Bouillon R, Moody T, Sporn M, Barrett JC, Norman AW . NIH deltanoids meeting on vitamin D and cancer. Conclusion and strategic options. J Steroid Biochem Mol Biol 2005; 97: 3–5.
Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR . Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 2002; 30: 771–777.
Holick MF . Vitamin D Deficiency. N Engl J Med 2007; 357: 266.
Hollis BW, Wagner CL . Normal serum vitamin D levels. N Engl J Med 2005; 352: 515–516.
Neuprez A, Bruyere O, Collette J, Reginster JY . Vitamin D inadequacy in Belgian postmenopausal osteoporotic women. BMC Public Health 2007; 7: 64.
Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007; 85: 649–650.
IOM Dietary Reference Intakes for Calcium and Vitamin D. Food and Nutrition Board: Washington, DC, 2011.
The Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality File, Mortality Follow-up Through 2006: Matching Methodology., National Center for Health Statistics, Office of Analysis and Epidemiology: Hyattsville, MD, 2009 available from: http://www.cdc.gov/nchs/data/datalinkage/matching_methodology_nhanes3_final.pdf.
Andersson T, Alfredsson L, Kallberg H, Zdravkovic S, Ahlbom A . Calculating measures of biological interaction. Eur J Epidemiol 2005; 20: 575–579.
Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM . The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc 2008; 56: 454–461.
Janssen HC, Samson MM, Verhaar HJ . Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr 2002; 75: 611–615.
Wolff AE, Jones AN, Hansen KE . Vitamin D and musculoskeletal health. Nat Clin Pract Rheumatol 2008; 4: 580–588.
Laird E, Ward M, McSorley E, Strain JJ, Wallace J . Vitamin D and bone health: potential mechanisms. Nutrients 2010; 2: 693–724.
Mason RS, Sequeira VB, Gordon-Thomson C . Vitamin D: the light side of sunshine. Eur J Clin Nutr 2011; 65: 986–993.
Verhaar HJ, Samson MM, Jansen PA, de Vreede PL, Manten JW, Duursma SA . Muscle strength, functional mobility and vitamin D in older women. Aging 2000; 12: 455–460.
Grady D, Halloran B, Cummings S, Leveille S, Wells L, Black D et al. 1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial. J Clin Endocrinol Metab 1991; 73: 1111–1117.
Acknowledgements
The work was partially supported by grants from the General Research Fund Award, the Oregon State University (ES), the National Institutes of Health (1 R25 GM086349-01 to CJC) and the Canada Research Chairs Program (REA).
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Smit, E., Crespo, C., Michael, Y. et al. The effect of vitamin D and frailty on mortality among non-institutionalized US older adults. Eur J Clin Nutr 66, 1024–1028 (2012). https://doi.org/10.1038/ejcn.2012.67
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DOI: https://doi.org/10.1038/ejcn.2012.67
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