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Minerals, trace elements, vit. D and bone health

Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people

Abstract

Background/Objectives:

Serum 25-hydroxyvitamin D (25(OH)D) status has been associated with muscle mass, strength and physical performance in healthy elderly people. Yet, in pre-frail and frail elderly people this association has not been studied. The objective of this study was to explore the association between vitamin D intake and serum 25(OH)D status with muscle mass, strength and physical performance in a pre-frail and frail elderly population.

Subjects/Methods:

This cross-sectional study included 127 pre-frail and frail elderly people in The Netherlands. Whole body and appendicular lean mass (ALM) (dual energy X-ray absorptiometry), leg strength (one repetition maximum), handgrip strength and physical performance (short physical performance battery) were measured, and blood samples were collected for the assessment of serum 25(OH)D status (liquid chromatography-tandem mass spectrometry). In addition, habitual dietary intake (3-day food records) and physical activity data (accelerometers) were collected.

Results:

In total, 53% of the participants had a serum 25(OH)D level below 50 nmol/l. After adjustment for confounding factors, 25(OH)D status was associated with ALM (β=0.012, P=0.05) and with physical performance (β=0.020, P<0.05). Vitamin D intake was associated with physical performance (β=0.18, P<0.05) but not with ALM (P>0.05).

Conclusion:

In this frail elderly population, 25(OH)D status is low and suggests a modest association with reduced ALM and impaired physical performance. In addition, vitamin D intake tended to be associated with impaired physical performance. Our findings highlight the need for well-designed intervention trials to assess the impact of vitamin D supplementation on 25(OH)D status, muscle mass and physical performance in pre-frail and frail elderly people.

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References

  1. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B . The I.A.N.A task force on frailty assessment of older people in clinical practice. J Nutr Health Aging 12: 29–37.

  2. 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 56: M146–M156.

  3. Evans WJ, Paolisso G, Abbatecola AM, Corsonello A, Bustacchini S, Strollo F et al. Frailty and muscle metabolism dysregulation in the elderly. Biogerontology 11: 527–536.

  4. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39: 412–423.

  5. Scott D, Blizzard L, Fell J, Ding C, Winzenberg T, Jones G . A prospective study of the associations between 25-hydroxy-vitamin D, sarcopenia progression and physical activity in older adults. Clin Endocrinol (Oxf) 73: 581–587.

  6. Visser M, Deeg DJ, Lips P, Longitudinal Aging Study A. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 88: 5766–5772.

  7. Ross AC, Taylor CL, Yaktine AL, Del Valle HB 2011 Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press (US): Washington (DC).

    Google Scholar 

  8. Burnand B, Sloutskis D, Gianoli F, Cornuz J, Rickenbach M, Paccaud F et al. Serum 25-hydroxyvitamin D: distribution and determinants in the Swiss population. Am J Clin Nutr 56: 537–542.

  9. Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90: 4119–4123.

  10. van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ et al. Potentially modifiable determinants of vitamin D status in an older population in The Netherlands: the Hoorn Study. Am J Clin Nutr 85: 755–761.

  11. Pilz S, Dobnig H, Tomaschitz A, Kienreich K, Meinitzer A, Friedl C et al. Low 25-hydroxyvitamin D is associated with increased mortality in female nursing home residents. J Clin Endocrinol Metab 97: E653–E657.

  12. Chel V, Wijnhoven HA, Smit JH, Ooms M, Lips P 2008. Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. Osteoporos Int 19: 663–671.

    Article  CAS  Google Scholar 

  13. Ceglia L 2008. Vitamin D and skeletal muscle tissue and function. Mol Aspects Med 29: 407–414.

    Article  CAS  Google Scholar 

  14. Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H . Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 20: 315–322.

  15. Wicherts IS, van Schoor NM, Boeke AJ, Visser M, Deeg DJ, Smit J et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab 92: 2058–2065.

  16. Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 330: 1769–1775.

  17. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339: b3692.

  18. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B . Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293: 2257–2264.

  19. Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP . A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 55: 234–239.

  20. Wilhelm-Leen ER, Hall YN, Deboer IH, Chertow GM . Vitamin D deficiency and frailty in older Americans. J Intern Med 268: 171–180.

  21. Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, Van De Rest O, De Groot LC et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 13: 713–719.

  22. Tieland M, Van De Rest O, Dirks ML, Van Der Zwaluw N, Mensink M, Van Loon LJ et al. Protein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 13: 720–726.

  23. Alberti KG, Zimmet PZ . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15: 539–553.

  24. Mandayam S, Mitch WE . Dietary protein restriction benefits patients with chronic kidney disease. Nephrology (Carlton) 11: 53–57.

  25. Witard OC, Tieland M, Beelen M, Tipton KD, Van Loon LJC, Koopman R . Resistance exercise increases postprandial muscle protein synthesis in humans. Med Sci Sport Exer 41: 144–154.

  26. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49: M85–M94.

  27. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al. The 2011 Dietary Reference Intakes for Calcium and Vitamin D: What Dietetics Practitioners Need to Know. J Am Diet Assoc 111: 524–527.

  28. Carnevale V, Modoni S, Pileri M, Di Giorgio A, Chiodini I, Minisola S et al. Longitudinal evaluation of vitamin D status in healthy subjects from southern Italy: seasonal and gender differences. Osteoporos Int 12: 1026–1030.

  29. Ceglia L, Chiu GR, Harris SS, Araujo AB . Serum 25-hydroxyvitamin D concentration and physical function in adult men. Clin Endocrinol (Oxf) 74: 370–376.

  30. Di Monaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R . Appendicular lean mass does not mediate the significant association between vitamin D status and functional outcome in hip-fracture women. Arch Phys Med Rehabil 92: 271–276.

  31. Ceglia L . Vitamin D and its role in skeletal muscle. Curr Opin Clin Nutr Metab Care 12: 628–633.

  32. Garcia LA, King KK, Ferrini MG, Norris KC, Artaza JN . 1,25(OH)2vitamin D3 stimulates myogenic differentiation by inhibiting cell proliferation and modulating the expression of promyogenic growth factors and myostatin in C2C12 skeletal muscle cells. Endocrinology 152: 2976–2986.

  33. Sato Y, Iwamoto J, Kanoko T, Satoh K . Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovasc Dis 20: 187–192.

  34. Perera S, Mody SH, Woodman RC, Studenski SA . Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 54: 743–749.

  35. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged&gt;or =60 y. Am J Clin Nutr 80: 752–758.

  36. Dam TT, von Muhlen D, Barrett-Connor EL . Sex-specific association of serum vitamin D levels with physical function in older adults. Osteoporos Int 20: 751–760.

  37. Gerdhem P, Ringsberg KA, Obrant KJ, Akesson K . Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 16: 1425–1431.

  38. 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 62: 440–446.

  39. Houston DK, Tooze JA, Davis CC, Chaves PH, Hirsch CH, Robbins JA et al. Serum 25-hydroxyvitamin D and physical function in older adults: the Cardiovascular Health Study All Stars. J Am Geriatr Soc 59: 1793–1801.

  40. Stockton KA, Mengersen K, Paratz JD, Kandiah D, Bennell KL . Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int 22: 859–871.

  41. Verreault R, Semba RD, Volpato S, Ferrucci L, Fried LP, Guralnik JM . Low serum vitamin d does not predict new disability or loss of muscle strength in older women. J Am Geriatr Soc 50: 912–917.

  42. Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B . Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med 166: 424–430.

  43. Zhu K, Austin N, Devine A, Bruce D, Prince RL . A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency. J Am Geriatr Soc 58: 2063–2068.

  44. Moreira-Pfrimer LD, Pedrosa MA, Teixeira L, Lazaretti-Castro M . Treatment of vitamin D deficiency increases lower limb muscle strength in institutionalized older people independently of regular physical activity: a randomized double-blind controlled trial. Ann Nutr Metab 54: 291–300.

  45. Cashman KD, Fitzgerald AP, Kiely M, Seamans KM . A systematic review and meta-regression analysis of the vitamin D intake-serum 25-hydroxyvitamin D relationship to inform European recommendations. Br J Nutr 106: 1638–1648.

  46. Bischoff-Ferrari HA, Dawson-Hughes B, Stocklin E, Sidelnikov E, Willett WC, Orav EJ et al. Oral supplementation with 25(OH)D(3) versus vitamin D(3): effects on 25(OH)D levels, lower extremity function, blood pressure and markers of innate immunity. J Bone Miner Res 27: 160–169.

  47. Black LJ, Seamans KM, Cashman KD, Kiely M . An updated systematic review and meta-analysis of the efficacy of vitamin d food fortification. J Nutr 142: 1102–1108.

  48. Cashman KD, Seamans KM, Lucey AJ, Stocklin E, Weber P, Kiely M et al. Relative effectiveness of oral 25-hydroxyvitamin D3 and vitamin D3 in raising wintertime serum 25-hydroxyvitamin D in older adults. Am J Clin Nutr 95: 1350–1356.

  49. Chin APMJ vanPoppel MN, Van Mechelen W . Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial. BMC Geriatr 6: 9.

  50. MacLaughlin J, Holick MF . Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76: 1536–1538.

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Acknowledgements

We gratefully acknowledge the expert assistance of Marlou Dirks, Nikita van der Zwaluw, Ondine van de Rest, Antoine Zorenc, Lex Verdijk, Marco Mensink, Lucy Okma, Jantien Takens, Fenglian Hu, Lieneke Homans and all volunteers and students that participated in this study. Furthermore, we greatly acknowledge all the elderly subjects who volunteered to participate in this study.

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Correspondence to M Tieland.

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Tieland, M., Brouwer-Brolsma, E., Nienaber-Rousseau, C. et al. Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people. Eur J Clin Nutr 67, 1050–1055 (2013). https://doi.org/10.1038/ejcn.2013.144

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