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J Am Geriatr Soc. 2017 Mar;65(3):619-624. doi: 10.1111/jgs.14677. Epub 2016 Dec 23.

The Association of Vitamin D Deficiency and Incident Frailty in Older Women: The Role of Cardiometabolic Diseases.

Author information

1
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
2
Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
3
Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland.
4
Benjamin Leon Center for Geriatric Research and Education and Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
5
Intramural Research Program, National Institute on Aging, Baltimore, Maryland.
6
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
7
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
8
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
9
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
10
Mailman School of Public Health, Columbia University, New York, New York.

Abstract

OBJECTIVES:

Evidence suggests vitamin D deficiency is associated with developing frailty. However, cardiometabolic factors are related to both conditions and may confound and/or mediate the vitamin D-frailty association. We aimed to determine the association of vitamin D concentration with incidence of frailty, and the role of cardiometabolic diseases (cardiovascular disease, diabetes, hyperlipidemia, hypertension) in this relationship.

DESIGN:

Prospective longitudinal cohort study (7 visits from 1994-2008).

SETTING:

Baltimore, Maryland.

PARTICIPANTS:

Three hundred sixty-nine women from the Women's Health and Aging Study II aged 70-79 years, free of frailty at baseline.

MEASUREMENTS:

Serum circulating 25-hydroxyvitamin D (25[OH]D) concentration was assessed at baseline and categorized as: <10; 10-19.9; 20-29.9; and ≥30 ng/mL. Frailty incidence was determined based on presence of three or more criteria: weight loss, low physical activity, exhaustion, weakness, and slowness. Cardiometabolic diseases were ascertained at baseline. Analyses included Cox regression models adjusted for key covariates.

RESULTS:

Incidence rate of frailty was 32.2 per 1,000 person-years in participants with 25(OH)D < 10 ng/mL, compared to 12.9 per 1,000 person-years in those with 25(OH)D ≥ 30 ng/mL (mean follow-up = 8.5 ± 3.7 years). In cumulative incidence analyses, those with lower 25(OH)D exhibited higher frailty incidence, though differences were non-significant (P = .057). In regression models adjusted for demographics, smoking, and season, 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) was associated with nearly three-times greater frailty incidence (hazard ratio (HR) = 2.77, 95% CI = 1.14, 6.71, P = .02). After adjusting for BMI, the relationship of 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) with incident frailty persisted, but was attenuated after further accounting for cardiometabolic diseases (HR = 2.29, 95% CI = 0.92, 5.69, P = .07).

CONCLUSION:

Low serum vitamin D concentration is associated with incident frailty in older women; interestingly, the relationship is no longer significant after accounting for the presence of cardiometabolic diseases. Future studies should explore mechanisms to explain this relationship.

KEYWORDS:

aging; cardiometabolic diseases; frailty; vitamin D

PMID:
28008596
PMCID:
PMC5357177
DOI:
10.1111/jgs.14677
[Indexed for MEDLINE]
Free PMC Article

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