Association of low 25-hydroxyvitamin D levels with the frailty syndrome in an aged population: Results from the KORA-Age Augsburg study

Abstract

Objectives

Older adults often suffer from vitamin D deficiency and from the frailty syndrome charac-terized by different physical limitations, complicating independent everyday life. Previous studies have suggested a relationship between vitamin D status and the frailty syndrome, but results have been partly inconsistent, particularly regarding the shape of the association. Therefore, our aim was to further assess the association of 25-hydroxyvitamin D (25(OH)D) serum levels and frailty in older participants.

Design

Cross-sectional population-based study.

Participants

The study population included 478 men and 462 women of the KORA (COoperative health research in the Region of Augsburg)-Age study born before 1944 examined in 2009.

Measurements

Classification of participants into different frailty states was performed according to the following criteria: weight loss, exhaustion, physical inactivity, slowness, and weakness. Participants who met 1−2 or ≥3 of the 5 criteria were classified as prefrail or frail, respectively. Total 25(OH)D was measured in non-fasting serum samples with an enhanced chemiluminescence immunoassay. Sequential logistic regression models adjusted for age, sex, season, lifestyle factors, diseases and biomarkers including parathyroid hormone (PTH) were calculated.

Results

High levels of 25(OH)D were inversely associated with being prefrail (N=351) or frail (N=38) in the model adjusted for age, sex, season and lifestyle factors. Compared to levels <15 ng/ml, odds ratios (ORs) (95% confidence intervals (CIs) were 0.52 (0.34–0.78) for levels of 15−<20 ng/ml, 0.55 (0.37–0.81) for levels of 20−<30 ng/ml and 0.32 (0.21–0.51) for levels ≥30 ng/ml. Additional adjustment for potential mediators including PTH only slightly attenuated these associations. For single frailty-components, significantly decreased ORs were found for exhaustion, physical inactivity and slowness comparing 25(OH)D levels ≥30 ng/ml with levels <15 ng/ml.

Conclusion

Subjects with 25(OH)D serum levels ≥15 ng/ml were less frequently prefrail or frail.

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References

  1. 1.

    Morley JE, Haren MT, Rolland Y, Kim MJ. Frailty. Med Clin North Am. 2006;90(5):837–47. doi:10.1016/j.mcna.2006.05.019.

    Article  PubMed  Google Scholar 

  2. 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. 2001;56(3):M146–56.

    Article  Google Scholar 

  3. 3.

    Morley JE, Perry HM, Miller DK. Editorial: Something about frailty. J Gerontol A Biol Sci Med Sci. 2002;57(11):M698–704.

    Article  Google Scholar 

  4. 4.

    Evans WJ, Paolisso G, Abbatecola AM, Corsonello A, Bustacchini S, Strollo F et al. Frailty and muscle metabolism dysregulation in the elderly. Biogerontology. 2010;11(5):527–36. doi:10.1007/s10522-010-9297-0.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81. doi:10.1056/NEJMra070553.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    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(1):69–75. doi:10.1093/gerona/gln007.

    Article  PubMed  Google Scholar 

  7. 7.

    Wilhelm-Leen ER, Hall YN, Deboer IH, Chertow GM. Vitamin D deficiency and frailty in older Americans. J Intern Med. 2010;268(2):171–80. doi:10.1111/j.1365-2796.2010.02248.x.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. 8.

    Ensrud KE, Blackwell TL, Cauley JA, Cummings SR, Barrett-Connor E, Dam TT et al. Circulating 25-hydroxyvitamin D levels and frailty in older men: the osteoporotic fractures in men study. J Am Geriatr Soc. 2011;59(1):101–6. doi:10.1111/j.1532-5415.2010.03201.x.

    Article  PubMed Central  PubMed  Google Scholar 

  9. 9.

    Ensrud KE, Ewing SK, Fredman L, Hochberg MC, Cauley JA, Hillier TA et al. Circulating 25-hydroxyvitamin D levels and frailty status in older women. J Clin Endocrinol Metab. 2010;95(12):5266–73. doi:10.1210/jc.2010-2317.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. 10.

    Hirani V, Naganathan V, Cumming RG, Blyth F, Le Couteur DG, Handelsman DJ et al. Associations between frailty and serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d concentrations in older Australian men: the concord health and ageing in men project. J Gerontol A Biol Sci Med Sci. 2013;68(9):1112–21. doi:10.1093/gerona/glt059.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Scharla SH. Prevalence of subclinical vitamin D deficiency in different European countries. Osteoporos Int.8 Suppl. 1998;2:S7–12.

    Article  Google Scholar 

  12. 12.

    Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22(4):477–501.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Max-Rubner-Institut. [National Nutrition Survey 2]. Karlsruhe, 2008.

  14. 14.

    Löwel H, Döring A, Schneider A, Heier M, Thorand B, Meisinger C. The MONICA Augsburg surveys—basis for prospective cohort studies. Gesundheitswesen. 2005;67 Suppl 1:S13–8. doi:10.1055/s-2005-858234.

    Article  Google Scholar 

  15. 15.

    Holle R, Happich M, Lowel H, Wichmann HE. KORA—a research platform for population based health research. Gesundheitswesen. 2005;67 Suppl 1:S19–25. doi:10.1055/s-2005-858235.

    Article  Google Scholar 

  16. 16.

    Peters A, Döring A, Ladwig KH, Meisinger C, Linkohr B, Autenrieth CS et al. Multimorbidität und erfolgreiches Altern: ein Blick auf die Bevölkerung im Rahmen der KORA-Age-Studie. Zeitschrift für Gerontologie und Geriatrie. 2011;44(2):41.

    Article  PubMed  Google Scholar 

  17. 17.

    Johar H, Emeny RT, Bidlingmaier M, Reincke M, Thorand B, Peters A et al. Blunted diurnal cortisol pattern is associated with frailty: A cross-sectional study of 745 participants aged 65 to 90 years. J Clin Endocrinol Metab. 2014;99(3):464–8. doi:10.1210/jc.2013-3079.

    Google Scholar 

  18. 18.

    Podsiadlo D, Richardson S. The timed «Up & Go»: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.

    CAS  PubMed  Google Scholar 

  19. 19.

    Larsson A, Malm J, Grubb A, Hansson LO. Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin C values in mg/L. Scand J Clin Lab Invest. 2004;64(1):25–30.

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395–406. doi:10.1053/j.ajkd.2007.11.018.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. 21.

    Hastie TJ, Tibshirani RJ. Generalized additive models. Monographs on statistics and applied probability, vol 43. Chapman and Hall, London, 1990

  22. 22.

    Hastie TJ, Tibshirani RJ. Generalized additive models. Statist Sci. 1986;1(3):297–318.

    Article  Google Scholar 

  23. 23.

    Hirani V, Cumming RG, Blyth FM, Naganathan V, Le Couteur DG, Handelsman DJ et al. Vitamin D status among older community dwelling men living in a sunny country and associations with lifestyle factors: the Concord Health and Ageing in Men Project, Sydney, Australia. J Nutr Health Aging. 2013;17(7):587–93. doi:10.1007/s12603-013-0013-z.

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Rosen CJ, Manson JE. Frailty: a D-ficiency syndrome of aging? J Clin Endocrinol Metab. 2010;95(12):5210–2. doi:10.1210/jc.2010-2544.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Ceglia L. Vitamin D and skeletal muscle tissue and function. Mol Aspects Med. 2008;29(6):407–14. doi:10.1016/j.mam.2008.07.002.

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Snijder MB, van Schoor NM, Pluijm SM, van Dam RM, Visser M, Lips P. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab. 2006;91(8):2980–5. doi:10.1210/jc.2006-0510.

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr. 2002;75(4):611–5.

    CAS  PubMed  Google Scholar 

  28. 28.

    Visser M, Deeg DJ, Lips P. 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. 2003;88(12):5766–72. doi:10.1210/jc.2003-030604.

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Dupuy C, Lauwers-Cances V, van Kan GA, Gillette S, Schott AM, Beauchet O et al. Dietary vitamin D intake and muscle mass in older women. Results from a cross-sectional analysis of the EPIDOS study. J Nutr Health Aging. 2013;17(2):119–24. doi:10.1007/s12603-012-0089-x.

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Holick MF. Vitamin D and bone health. J Nutr. 1996;126(4 Suppl):1159S–64S.

    CAS  PubMed  Google Scholar 

  31. 31.

    Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881–6. doi:10.231/JIM.0b013e31821b8755.

    PubMed Central  CAS  PubMed  Google Scholar 

  32. 32.

    Roland KP, Cornett KMD, Theou O, Jakobi JM, Jones GR. Physical Activity across Frailty Phenotypes in Females with Parkinson’s Disease. J Aging Res. 2012:468–156. doi:10.1155/2012/468156.

    Google Scholar 

  33. 33.

    Newman AB, Gottdiener JS, McBurnie MA, Hirsch CH, Kop WJ, Tracy R et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci. Med Sci. 2001;56(3):M158–66.

    Article  Google Scholar 

  34. 34.

    Seshadri KG, Tamilselvan B, Rajendran A. Role of Vitamin D in Diabetes. J Endocrinol Metab. 2011;1(2):47–56. doi:10.4021/jem23w.

    CAS  Google Scholar 

  35. 35.

    Small RS. Vitamin D and the heart. The Journal of Lancaster General Hospital. 2006;1(3):99–102.

    Google Scholar 

  36. 36.

    Schwab S, Heier M, Schneider A, Fischer B, Huth C, Peters A et al. The use of dietary supplements among older persons in Southern Germany — Results from the KORA-age study. J Nutr Health Aging. 2014;18(5):510–9. doi:10.1007/s12603-013-0418-8.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Ovesen L, Andersen R, Jakobsen J. Geographical differences in vitamin D status, with particular reference to European countries. Proc Nutr Soc. 2003;62(4):813–21. doi:10.1079/PNS2003297.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Barbara Thorand.

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Pabst, G., Zimmermann, AK., Huth, C. et al. Association of low 25-hydroxyvitamin D levels with the frailty syndrome in an aged population: Results from the KORA-Age Augsburg study. J Nutr Health Aging 19, 258–264 (2015). https://doi.org/10.1007/s12603-014-0546-9

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Key words

  • 25(OH)D
  • frailty
  • KORA-Age
  • Vitamin D