Objective: Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality. Design: The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (O65 years) in 11 nursing homes in Sweden. Methods: We analysed the levels of 25-hydroxyvitamin D 3 (25(OH)D 3 ) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D 3 quartiles were calculated. Results: We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D 3 O48 nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D 3 !29 nmol/l) (P!0.05); 2.03 (1.32-3.14) in Q2 (25(OH)D 3 30-37 nmol/l) (P!0.05) and 1.6 (1.03-2.48) in Q3 (25(OH) D 3 38-47 nmol/l) (P!0.05). The mean 25(OH)D 3 concentration was 40.2 nmol/l (S.D. 16.0) and 80% had 25(OH)D 3 below 50 nmol/l. The vitamin D levels decreased from baseline to the second and third measurements. Conclusions: Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.

Low 25(OH)D is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.

Objectives: Older people are recommended to take oral vitamin D supplements, but the main source of vitamin D is sunlight. Our aim was to explore whether active encouragement to spend time outdoors could increase the levels of serum 25-hydroxyvitamin D (25(OH)D) and increase the mental well-being of nursing home residents. Design: A cluster randomized intervention trial. Setting: Nursing homes in southern Sweden. Participants: In total 40 people >65 years. Intervention : The intervention group was encouraged to go outside for 20-30 minutes between 11 a.m. and 3 p.m. every day for two months during the summer of 2018. Measurements: We analyzed serum 25(OH)D before and after the summer. Data from SF-36 questionnaires measuring vitality and mental health were used for the analyses. Results: In the intervention group, the baseline median (interquartile range (IQR)) of serum 25(OH)D was 42.5 (23.0) nmol/l and in the control group it was 52.0 (36.0) nmol/l. In the intervention group, the 25(OH)D levels increased significantly during the summer (p=0.011). In the control group, there was no significant change. The intervention group reported better self-perceived mental health after the summer compared to before the summer (p=0.015). In the control group, there was no difference in mental health. Conclusion: Active encouragement to spend time outdoors during summertime improved the levels of serum 25(OH)D and self-perceived mental health significantly in older people in nursing homes and could complement or replace oral vitamin D supplementation in the summer.

Purpose There are limited and inconsistent results on the correlation between vitamin D and mental health in patients with type 2 diabetes (T2D). Thus, our aim was to explore the association between vitamin D and mental well-being in a community-based sample of participants with T2D. Methods We analyzed serum 25-hydroxyvitamin D 3 (25(OH)D 3) in 698 patients with T2D at the baseline examination. The cohort was reinvestigated after 4 years. Data from SF-36 questionnaires measuring vitality and mental health at baseline and after 4 years were used for analyses. Results Serum 25(OH)D 3 was inversely associated with poor mental health at baseline (odds ratio (OR) for 10 nmol/l increase in 25(OH)D 3 , 0.90 (95% confidence interval (CI) 0.83-0.96, p = 0.003)) but not at follow-up (p > 0.05). Serum 25(OH)D 3 was not associated with vitality at baseline (p > 0.05). At follow-up, there was an inverse association between 25(OH)D 3 and low vitality (OR for 10 nmol/l increase in 25(OH)D 3 , 0.89 (95% CI 0.82-0.97, p = 0.009)) but not after adjustment. Conclusion We found an inverse association between 25(OH)D 3 and mental health in patients with T2D at baseline. We found no association between 25(OH)D 3 and vitality after adjustment. Future studies are needed to determine the association between vitamin D and mental well-being in patients with T2D.

BackgroundInstitutionalised elderly people living in northern latitudes may be at elevated risk for vitamin D deficiency. They are recommended to take oral vitamin D supplements, but the main source of vitamin D is sunlight. Previous studies have shown an association between low levels of vitamin