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J Intern Med. 2016 Sep;280(3):300-11. doi: 10.1111/joim.12491. Epub 2016 Apr 1.

Vitamin D insufficiency and cognitive impairment in Asians: a multi-ethnic population-based study and meta-analysis.

Annweiler C1,2, Milea D3,4,5,6, Whitson HE7,8,9, Cheng CY3,4,10,11, Wong TY3,4,10,11, Ikram MK3,12, Lamoureux EL3,4,10,11, Sabanayagam C3,10,11.

Author information

1
Division of Geriatric Medicine, Department of Neuroscience, Angers University Hospital, University Memory Clinic of Angers, UNAM, University of Angers, Angers, France.
2
Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada.
3
Singapore Eye Research Institute, Singapore.
4
Singapore National Eye Centre, Singapore.
5
Neuroscience and Behavioural Disorders, Duke-NUS, Singapore.
6
Division of Ophthalmology, Department of Neuroscience, Angers University Hospital, Angers, France.
7
Departments of Medicine and Ophthalmology, Duke University Medical School, Durham, NC, USA.
8
Duke Aging Center, Duke University, Durham, NC, USA.
9
Durham VA Medical Center, Geriatrics Research Education and Clinical Center, Durham, NC, USA.
10
Ophthalmology and Visual Sciences Academic Clinical Program, Medical School, Duke-NUS, Singapore.
11
Department of Ophthalmology, National University of Singapore, Singapore.
12
Memory Aging & Cognition Centre, National University Health System, Singapore.

Abstract

BACKGROUND:

The relationship between vitamin D insufficiency and cognitive impairment remains equivocal in Asians. We examined the association between circulating 25-hydroxyvitamin D (25OHD) concentration and cognitive performance in a large multi-ethnic Singaporean population-based study. We also conducted a meta-analysis of 25OHD concentrations amongst cognitively impaired older adults in Asia.

METHODS:

Our population-based cross-sectional study included 2273 persons ≥60 years of age from the Singapore Epidemiology of Eye Diseases (SEED) study (mean ± SD age 70.4 ± 6.2 years; 44.7% female), who were categorized according to 25OHD concentration (i.e. ≤10, 10.1-20 and >20 ng mL(-1) ). The 25OHD concentration was measured and adjusted to reflect a deseasonalized value. Cognition was assessed using the total and domain scores of the Abbreviated Mental Test (AMT). Global cognitive impairment was defined as AMT score of ≤6 if 0-6 years of education and AMT score of ≤8 if >7 years of education. Fully adjusted multivariate models were used. We included seven studies in a meta-analysis of 25OHD and cognition in Asia (6068 participants; 1179 cognitively impaired cases).

RESULTS:

Participants with 25OHD levels >20 ng mL(-1) (n = 1302) had higher AMT total scores (mean ± SD 8.5 ± 1.9) and were less likely to have cognitive impairment (14.1%) than participants with lower 25OHD levels (overall P < 0.001, P-trend < 0.001). Deseasonalized 25OHD concentration was associated with AMT score (β = 0.10 per 10 ng mL(-1) , P = 0.035). Vitamin D insufficiency (25OHD ≤20 ng mL(-1) ) was associated with global cognitive impairment (OR 1.56, P = 0.028). Specifically, 25OHD concentration correlated with semantic memory (r = 0.08, P = 0.009) and orientation in time (r = 0.09, P = 0.003). In the meta-analysis, the pooled mean 25OHD difference was -6.83 ng mL(-1) (95% confidence interval -11.36; -2.30), indicating lower 25OHD concentrations amongst cognitively impaired compared to cognitively healthy participants in Asia.

CONCLUSION:

Vitamin D insufficiency is associated with a greater likelihood of and more severe cognitive impairment in Asian populations.

KEYWORDS:

Asia; cognition; older adults; vitamin D

PMID:
27037788
DOI:
10.1111/joim.12491
[Indexed for MEDLINE]
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