Advertisement

25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study

  • D. LelliEmail author
  • L. M. Pérez Bazan
  • A. Calle Egusquiza
  • G. Onder
  • A. Morandi
  • E. Ortolani
  • M. Mesas Cervilla
  • C. Pedone
  • M. Inzitari
Original Article

Abstract

Summary

Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for “deficiency”). An early 25(OH)D dosage may be advisable for this population.

Introduction

Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units.

Methods

We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models.

Results

We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5–18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67–5.33]; Q3, OR [95% CI] = 4.01 [1.35–13.48]; Q4, OR [95% CI] = 2.18 [0.81–6.21]).

Conclusions

In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for “deficiency.” Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.

Keywords

Aged Barthel index Functional recovery Rehabilitation Vitamin D 

Notes

Compliance with ethical standards

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

198_2019_4845_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)

References

  1. 1.
    Holick MF (2006) High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 81:353–373.  https://doi.org/10.4065/81.3.353 CrossRefGoogle Scholar
  2. 2.
    MacLaughlin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538.  https://doi.org/10.1172/JCI112134 CrossRefGoogle Scholar
  3. 3.
    Cougnard-Grégoire A, Merle BMJ, Korobelnik J-F, Rougier MB, Delyfer MN, Féart C, le Goff M, Dartigues JF, Barberger-Gateau P, Delcourt C (2015) Vitamin D deficiency in community-dwelling elderly is not associated with age-related macular degeneration. J Nutr 145:1865–1872.  https://doi.org/10.3945/jn.115.214387 CrossRefGoogle Scholar
  4. 4.
    Looker AC, Pfeiffer CM, Lacher DA et al (2008) Serum 25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–2004. Am J Clin Nutr 88:1519–1527.  https://doi.org/10.3945/ajcn.2008.26182 CrossRefGoogle Scholar
  5. 5.
    Kiebzak GM, Moore NL, Margolis S, Hollis B, Kevorkian CG (2007) Vitamin D status of patients admitted to a hospital rehabilitation unit: relationship to function and progress. Am J Phys Med Rehabil 86:435–445.  https://doi.org/10.1097/PHM.0b013e31805b7e20 CrossRefGoogle Scholar
  6. 6.
    Reid IR (2017) Vitamin D effect on bone mineral density and fractures. Endocrinol Metab Clin N Am 46:935–945.  https://doi.org/10.1016/j.ecl.2017.07.005 CrossRefGoogle Scholar
  7. 7.
    Bischoff-Ferrari HA (2012) Relevance of vitamin D in muscle health. Rev Endocr Metab Disord 13:71–77.  https://doi.org/10.1007/s11154-011-9200-6 CrossRefGoogle Scholar
  8. 8.
    Granic A, Hill TR, Davies K, Jagger C, Adamson A, Siervo M, Kirkwood T, Mathers J, Sayer A (2017) Vitamin D status, muscle strength and physical performance decline in very old adults: a prospective study. Nutrients 9.  https://doi.org/10.3390/nu9040379
  9. 9.
    Hirani V, Cumming RG, Naganathan V, Blyth F, le Couteur DG, Handelsman DJ, Waite LM, Seibel MJ (2014) Associations between serum 25-hydroxyvitamin D concentrations and multiple health conditions, physical performance measures, disability, and all-cause mortality: the concord health and ageing in men project. J Am Geriatr Soc 62:417–425.  https://doi.org/10.1111/jgs.12693 CrossRefGoogle Scholar
  10. 10.
    Janssen HCJP, Emmelot-Vonk MH, Verhaar HJJ, van der Schouw YT (2013) Vitamin D and muscle function: is there a threshold in the relation? J Am Med Dir Assoc 14:627.e13–627.e18.  https://doi.org/10.1016/j.jamda.2013.05.012 CrossRefGoogle Scholar
  11. 11.
    Sohl E, van Schoor NM, de Jongh RT, Visser M, Deeg DJH, Lips P (2013) Vitamin D status is associated with functional limitations and functional decline in older individuals. J Clin Endocrinol Metab 98:E1483–E1490.  https://doi.org/10.1210/jc.2013-1698 CrossRefGoogle Scholar
  12. 12.
    Wicherts IS, van Schoor NM, Boeke AJP, Visser M, Deeg DJH, Smit J, Knol DL, Lips P (2007) Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab 92:2058–2065.  https://doi.org/10.1210/jc.2006-1525 CrossRefGoogle Scholar
  13. 13.
    Annweiler C, Schott A-M, Berrut G, Chauviré V, le Gall D, Inzitari M, Beauchet O (2010) Vitamin D and ageing: neurological issues. Neuropsychobiology 62:139–150.  https://doi.org/10.1159/000318570 CrossRefGoogle Scholar
  14. 14.
    Houston DK, Neiberg RH, Tooze JA, Hausman DB, Johnson MA, Cauley JA, Bauer DC, Shea MK, Schwartz GG, Williamson JD, Harris TB, Kritchevsky SB, for the Health ABC Study (2013) Low 25-hydroxyvitamin D predicts the onset of mobility limitation and disability in community-dwelling older adults: the health ABC study. J Gerontol A Biol Sci Med Sci 68:181–187.  https://doi.org/10.1093/gerona/gls136 CrossRefGoogle Scholar
  15. 15.
    Antoniak AE, Greig CA (2017) The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. BMJ Open 7:e014619.  https://doi.org/10.1136/bmjopen-2016-014619 CrossRefGoogle Scholar
  16. 16.
    Pellicane AJ, Wysocki NM, Mallinson TR, Schnitzer TJ (2011) Prevalence of 25-hydroxyvitamin D deficiency in the acute inpatient rehabilitation population and its effect on function. Arch Phys Med Rehabil 92:705–711.  https://doi.org/10.1016/j.apmr.2010.12.028 CrossRefGoogle Scholar
  17. 17.
    Di Monaco M, Vallero F, Di Monaco R et al (2006) 25-hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients. J Bone Miner Metab 24:42–47.  https://doi.org/10.1007/s00774-005-0644-1 CrossRefGoogle Scholar
  18. 18.
    Curtis E, Litwic A, Cooper C, Dennison E (2015) Determinants of muscle and bone aging. J Cell Physiol 230:2618–2625.  https://doi.org/10.1002/jcp.25001 CrossRefGoogle Scholar
  19. 19.
    Sainsbury A, Seebass G, Bansal A, Young JB (2005) Reliability of the Barthel index when used with older people. Age Ageing 34:228–232.  https://doi.org/10.1093/ageing/afi063 CrossRefGoogle Scholar
  20. 20.
    Ross AC, Manson JE, Abrams SA et al (2011) 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 96:53–58.  https://doi.org/10.1210/jc.2010-2704 CrossRefGoogle Scholar
  21. 21.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930.  https://doi.org/10.1210/jc.2011-0385 CrossRefGoogle Scholar
  22. 22.
    Markišić M, Pavlović AM, Pavlović DM (2017) The impact of homocysteine, vitamin B12, and vitamin D levels on functional outcome after first-ever ischaemic stroke. Biomed Res Int 2017:5489057.  https://doi.org/10.1155/2017/5489057 Google Scholar
  23. 23.
    Wei Z-N, Kuang J-G (2018) Vitamin D deficiency in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke. Biosci Rep 38:BSR20171509.  https://doi.org/10.1042/BSR20171509 CrossRefGoogle Scholar
  24. 24.
    Daumas A, Daubail B, Legris N, Jacquin-Piques A, Sensenbrenner B, Denimal D, Lemaire-Ewing S, Duvillard L, Giroud M, Béjot Y (2016) Association between admission serum 25-hydroxyvitamin D levels and functional outcome of thrombolyzed stroke patients. J Stroke Cerebrovasc Dis 25:907–913.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.005 CrossRefGoogle Scholar
  25. 25.
    Seng WRD, Belani MH, Ramason R, Naidu G, Doshi HK (2015) Functional improvement in geriatric hip fractures: does vitamin D deficiency affect the functional outcome of patients with surgically treated intertrochanteric hip fractures. Geriatr Orthop Surg Rehabil 6:186–191.  https://doi.org/10.1177/2151458515584639 CrossRefGoogle Scholar
  26. 26.
    Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B (2004) Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr 80:752–758.  https://doi.org/10.1093/ajcn/80.3.752 CrossRefGoogle Scholar
  27. 27.
    Shah MV (2006) Rehabilitation of the older adult with stroke. Clin Geriatr Med 22:469–489; xi.  https://doi.org/10.1016/j.cger.2005.12.012 CrossRefGoogle Scholar
  28. 28.
    Pfeifer M, Begerow B, Minne HW (2002) Vitamin D and muscle function. Osteoporos Int 13:187–194.  https://doi.org/10.1007/s001980200012 CrossRefGoogle Scholar
  29. 29.
    Rodman JS, Baker T (1978) Changes in the kinetics of muscle contraction in vitamin D-depleted rats. Kidney Int 13:189–193CrossRefGoogle Scholar
  30. 30.
    Lips P (2004) Which circulating level of 25-hydroxyvitamin D is appropriate? J Steroid Biochem Mol Biol 89–90:611–614.  https://doi.org/10.1016/j.jsbmb.2004.03.040 CrossRefGoogle Scholar
  31. 31.
    Evans WJ, Campbell WW (1993) Sarcopenia and age-related changes in body composition and functional capacity. J Nutr 123:465–468.  https://doi.org/10.1093/jn/123.suppl_2.465 CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Area di GeriatriaUniversità Campus Bio-Medico di RomaRomeItaly
  2. 2.Parc Sanitari Pere VirgiliBarcelonaSpain
  3. 3.Vall d’Hebrón Institute of ResearchBarcelonaSpain
  4. 4.Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
  5. 5.Centro Medicina dell’InvecchiamentoUniversità Cattolica del Sacro CuoreRomeItaly
  6. 6.Department of Rehabilitation and Aged Care of the Fondazione CamplaniAncelle HospitalCremonaItaly

Personalised recommendations