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80 percent of the characteristics of frailty associated with low vitamin D – May 2013

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 - 2013

J Gerontol A Biol Sci Med Sci. 2013 May 8.
Hirani V, Naganathan V, Cumming RG, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Seibel MJ.
Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, NSW 2139, Australia. vasant.hirani at sydney.edu.au.

BACKGROUND: Poor vitamin D status and frailty are common in older people and associated with adverse health outcomes. The aim of this study was to examine the associations between serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and frailty and components of frailty in older Australian men.

METHODS: Cross-sectional analysis of the Concord Health and Ageing in Men Project, a large epidemiological study conducted in Sydney, Australia, between January 2005 and May 2007.
Participants included 1,659 community-dwelling men.
Main outcome measurements were frailty (assessed using the Cardiovascular Health Study), frailty criteria comprising five core components:

  • weight loss;
  • reduced muscular strength/weakness;
  • slow walking speed;
  • exhaustion; and
  • low activity level,

and the separate components of frailty. Covariates included serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels measured by radioimmunoassay, age, country of birth, season of blood collection, sun exposure, body mass index, vitamin D supplement use, income, measures of health, parathyroid hormone, estimated glomerular function.

RESULTS: Frailty was present in 9.2% of the sample.
Low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were independently associated with frailty and with four of the five components of frailty (except weight loss).

CONCLUSIONS: 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D levels were independently associated with frailty in older men.
This suggests that there might be a number of different biological mechanisms for how low vitamin D status might contribute to the frailty syndrome.
In addition, the possibility that improving vitamin D status may specifically influence the incidence and progression of frailty needs to be explored.

PMID: 23657973

Low vitamin D status is an independent predictor of increased frailty and all-cause mortality in older men: the Health In Men Study - 2013

The Journal of Clinical Endocrinology & Metabolism June 20, 2013 jc.2013-1702
Yuen Y E Wong, MBBS1,2 ewong at meddent.uwa.edu.au, Kieran A McCaul, PhD1,2, Bu B Yeap, MBBS, PhD2,3, Graeme J Hankey, MD4 and Leon Flicker, MBBS, PhD1,2,5
1Western Australian Centre for Health and Ageing, Centre for Medical Research, Australia
2School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
3Department of Endocrinology and Diabetes, Fremantle Hospital, Perth, Australia
4Department of Neurology, Royal Perth Hospital, Perth, Australia
5Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia

Context and objective: Hypovitaminosis D and frailty are common in the older population.
We aimed to determine whether 25-hydroxyvitamin D [25(OH)D] concentrations are associated with frailty and mortality.

Design: Prospective cohort study.

Setting and participants: 4203 older men aged 70–88 years in Perth, Western Australia

Main outcome measures: 25(OH)D was measured by immunoassay. Frailty was assessed with the 5-point FRAIL (Fatigue, Resistance, Ambulation, Illness and Loss of weight) scale. Mortality was determined from the death registry via the Western Australian Data Linkage System.

Results: At baseline, 676 (16.1%) men were frail, as defined by having ≥3 deficits (FRAIL scale ≥ 3). In multivariate cross-sectional analysis, low vitamin D status, defined by the lowest quartile of 25(OH)D values (<52.9 nmol/l), was associated with increased prevalent frailty (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52 to 2.52) in comparison to the highest quartile of 25(OH)D values (>81.6 nmol/l). After a mean period of 5.3 years, the adjusted odds ratio of being frail at follow-up for men with low vitamin D and having zero deficit at baseline (FRAIL scale = 0) was 1.56 (95% CI 1.07 to 2.27). Low vitamin D also predicted all-cause mortality over a period of up to 9.2 years (hazards ratio 1.20, 95% CI 1.02 to 1.42), independent of baseline frailty and other covariates.

Conclusion: Hypovitaminosis D is associated with prevalent and incident frailty in older men.
Hypovitaminosis D also predicts all-cause mortality, independent of frailty.
The association between vitamin D and mortality is not solely dependent on the occurrence of frailty.

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80 percent of the characteristics of frailty associated with low vitamin D – May 2013        
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