Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality

Samefors, Maria; Östgren, Carl Johan; Mölstad, Sigvard; Lannering, Christina; Midlöv, Patrik; Tengblad, Anders

doi:10.1530/eje-13-0855

Cited by 45 publications

(47 citation statements)

References 41 publications

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“…Further, the in vitro inducibility of hCAP18 by 25D and 1,25D has been demonstrated in multiple human cell lines [10,18-22]. These preclinical studies are complemented by numerous observational studies in humans, which have consistently shown associations between decreased 25D levels and increased mortality in patients with critical illness [3-7] and in other settings [44-46]. The association between decreased 25D levels and adverse outcomes in critical illness has been postulated to be mediated, at least in part, by decreased production of hCAP18 [6,47,48], yet few studies have simultaneously measured 25D and hCAP18 and evaluated their association with adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients

et al. 2015

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IntroductionDecreased production of cathelicidin antimicrobial protein-18 (hCAP18) has been proposed to be a key mechanism linking decreased 25-hydroxyvitamin D (25D) levels with adverse outcomes among critically ill patients. However, few studies in humans have directly assessed plasma hCAP18 levels, and no study has evaluated the association between hCAP18 levels and adverse outcomes among critically ill patients.MethodsWe performed a single-center, prospective cohort study among 121 critically ill patients admitted to intensive care units (ICUs) between 2008 and 2012. We measured plasma hCAP18, 25D, D-binding protein, and parathyroid hormone levels on ICU day 1. The primary endpoint was 90-day mortality. Secondary endpoints included hospital mortality, sepsis, acute kidney injury, duration of mechanical ventilation, and hospital length of stay.ResultsICU day 1 hCAP18 levels were directly correlated with 25D levels (Spearman’s rho (rs) = 0.30, P = 0.001). In multivariate analyses adjusted for age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, patients with hCAP18 levels in the lowest compared to highest tertile on ICU day 1 had a 4.49 (1.08 to 18.67) greater odds of 90-day mortality, and also had greater odds of sepsis. ICU day 1 levels of other analytes were not associated with 90-day mortality.ConclusionsLower 25D levels on ICU day 1 are associated with lower hCAP18 levels, which are in turn associated with a greater risk of 90-day mortality. These findings provide a potential mechanistic basis for the frequently observed association between low 25D levels and poor outcomes in critically ill patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0812-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients

et al. 2015

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“…Vitamin D level in Kazaks is much lower than in other ethnic populations [28–30]. In ethnic Chinese Han, the average concentration of 25(OH) D is 26.9ng/mL and the incidence of vitamin D deficiency is 28.6%, significantly higher than that in Kazaks [31].…”

Section: Discussionmentioning

confidence: 99%

Serum Vitamin D is Low and Inversely Associated with LDL Cholesterol in the Kazak Ethnic Population: A Cross-Sectional Study

Zhang

Liu

et al. 2014

Med Sci Monit

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BackgroundAccumulating evidence suggests that low concentrations of serum 25(OH)D is coupled with increased risks of hypertension, obesity, and cardiovascular disease. However, this relationship has not been established in populations with very low levels of 25(OH)D. Therefore, the aim of our study was to clarify the associations between 25(OH)D and blood pressure, obesity, sex, and lipid profiles in the Kazak ethnic population, who have an extremely low level of 25(OH)D.Material/MethodsA multistage-cluster sampling survey was carried out for residents with Kazak ethnicity in Xinjiang, China. Anthropometric measurements of each participant were taken and the concentrations of 25(OH)D, calcium, alkaline phosphatase, and lipid profiles were measured. Individuals were classified into different groups in terms of vitamin D status, degree of adiposity, presence of hypertension, and other comorbidities.ResultsThe madian concentration of 25(OH)D was 16.2 (11.8–20.5) ng/mL and the prevalence of vitamin D deficiency was 72.4% in this Kazak population (n=928, 59.0% women). Females had a lower 25(OH)D concentration than males – 14.6 (10.5–19.4) ng/mL vs. 17.7 (14.8–22.5) ng/mL, P<0.001. The subjects were classified into 3 groups according to their vitamin D status. There were significant differences in BMI (P=0.046), waist circumference (P=0.037), hip circumference (P=0.003), systolic BP (P=0.035), and LDL cholesterol (P=0.008) among the groups after adjustment for sex and age. On the other hand, there was no significant difference in vitamin D levels between groups with or without hypertension (P=0.586), and groups with or without obesity (P=0.639). A multifactor-regression analysis revealed that every increment of 1mg/dL in LDL cholesterol was associated with a 1.0 ng/mL decline in serum 25(OH)D.ConclusionsThe insufficiency of vitamin D is highly prevalent in Kazaks. Sex, LDL cholesterol, and hip circumference are 3 variables strongly associated with serum 25(OH)D concentration. In a population with low levels of 25(OH)D, the negative relationship between obesity and serum 25(OH)D, a common finding from most previous studies, could not be established.

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“…Older subjects with 25-Hydroxyvitamin D (25(OH)D) levels below 50–70 nmol/L have a significantly higher risk of earlier death than those with higher 25(OH)D levels [2,3,4]. Vitamin D deficiency may result in osteopenia/osteoporosis, muscle weakness, and atrophy (sarcopenia), poor balance, and an increased risk for fractures [5].…”

Section: Introductionmentioning

confidence: 99%

Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden

et al. 2016

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Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OH)D levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OH)D level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people ≥75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OH)D) < 50 nmol/L), in contrast with 49% of orthopedic patients with hip fractures (n = 133), 31% of stroke patients (n = 122), 39% of patients visiting the hospital’s emergency department ≥4 times a year (n = 81), and 75% of homebound adult residents in long-term care nursing homes (n = 51). The mean vitamin D concentration of the healthy control group (74 nmol/L) was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (<50 nmol/L). The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.

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Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality

Cited by 45 publications

References 41 publications

Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients

Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients

Serum Vitamin D is Low and Inversely Associated with LDL Cholesterol in the Kazak Ethnic Population: A Cross-Sectional Study

Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden

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