Risk factors for vitamin D deficiency and association with sarcopenia in people 65 years and older

BACKGROUND: Vitamin D deficiency has shown a significant role in the impairment of muscle mass maintenance and skeletal muscle function, which are progressively reduced in sarcopenic patients with sarcopenia in the elderly. However, there are different points of view about the relationship between vitamin D deficiency and sarcopenia.

AIM: to assess the frequency and risk factors for vitamin D deficiency and identify the relationship with sarcopenia in people 65 years of age and older.

MATERIALS AND METHODS: the study included 230 people 65 years of age and older (median age 75 [68; 79] years) who completed a questionnaire using the Mini-Mental State Examination (MMSE), International Physical Activity Questionnaire (IPAQ). Sarcopenia was diagnosed according to EWGSOP2 criteria (2018). 25(OH)D was determined by enzyme immunoassay (Architect i2000SR, Abbot, USA).

RESULTS: there were no differences in age, gender, physical activity, smoking and other social characteristics between people with and without vitamin D deficiency (p>0.05). Vitamin D deficiency was detected more often in people with low BMI and obesity (p<0.001). Probable sarcopenia was detected in 64.8% of people 65 years of age and older, confirmed — in 28.7%, severe — in 21.3% of people. Vitamin D deficiency increased the risk of sarcopenia (OR=4.989; 95% CI 1.321–12.626; p=0.0420) and was associated with low muscle strength (OR=2.613; 95% CI 1.993–3.270; p=0.00116), low physical performance according to the results of the SPPB tests (OR = 1.905; 95% CI 1.342–2.710; p=0.00034) and the Timed Up and Go test (OR=1.364; 95% CI 1.003–1.853; p=0.047).

CONCLUSION: vitamin D deficiency was detected in 58.7% of elderly people and was associated with insufficient BMI and obesity. In sarcopenic patients, vitamin D deficiency was detected in 72.7% and was associated with age, BMI less than 25 kg/m2, low physical activity and low skeletal muscle function.

1. Pludowski P, Grant WB, Konstantynowicz J, Holick MF. Editorial: Classic and pleiotropic actions of vitamin D. Front Endocrinol (Lausanne). 2019;(10):217-230. doi: https://doi.org/10.3389/fendo.2019.00341

2. Bikle DD. Vitamin D: Production, Metabolism and Mechanisms of Action. In: Feingold KR, Anawalt B, Boyce A, et al. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2021

3. Montenegro KR, Cruzat V, Carlessi R, Newsholme P. Mechanisms of vitamin D action in skeletal muscle. Nutr Res Rev. 2019;32(2):192-204 doi: https://doi.org/110.1017/S0954422419000064

4. Pigarova EA, Petrushkina AA. Non-classical effects of vitamin D. Osteoporosis and Bone Diseases. 2017;20(3):90-101. (In Russ.). doi: https://doi.org/10.14341/osteo2017390-101

5. Olsson K, Saini A, Strömberg A, et al. Evidence for Vitamin D Receptor Expression and Direct Effects of 1α,25(OH)2D3 in Human Skeletal Muscle Precursor Cells. Endocrinology. 2016;157(1):98-111. doi: https://doi.org/10.1210/en.2015-1685

6. Hii CS, Ferrante A. The Non-Genomic Actions of Vitamin D. Nutrients. 2016;8(3):135. doi: https://doi.org/10.3390/nu8030135

7. Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. Eur J Appl Physiol. 2019;119(4):825-839. doi: https://doi.org/10.1007/s00421-019-04104-x

8. Talbot J, Maves L. Skeletal muscle fiber type: using insights from muscle developmental biology to dissect targets for susceptibility and resistance to muscle disease. Wiley Interdiscip Rev Dev Biol. 2016;5(4):518-534. doi: https://doi.org/10.1002/wdev.230

9. Girgis CM, Cha KM, So B, et al. Mice with myocyte deletion of vitamin D receptor have sarcopenia and impaired muscle function. J. Cachexia Sarcopenia Muscle. 2019;10(6):1228-1240. doi: https://doi.org/10.1002/jcsm.12460

10. Kweder H, Eidi H. Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status. Avicenna J Med. 2018;8(4):139-146. doi: https://doi.org/10.4103/ajm.AJM_20_18

11. Lips P, Cashman KD, Lamberg-Allardt C, et.al. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. European Journal of Endocrinology. 2019;180(4):23-54. doi: https://doi.org/10.1530/EJE-18-0736.80,P23–P54

12. Carrillo-Vega MF, García-Peña C, Gutiérrez-Robledo LM, Pérez-Zepeda MU. Vitamin D deficiency in older adults and its associated factors: a cross-sectional analysis of the Mexican Health and Aging Study. Arch Osteoporos. 2017;12(1):8. doi: https://doi.org/10.1007/s11657-016-0297-9

13. Safonova YuA, Toroptsova NV. Vitamin D deficiency and insufficiency, risk factors and its correction in elderly people. Russian Medical Journal. 2021;(6):96-100 (In Russ.)

14. Hilger J, Friedel A, Herr R, et al. A systematic review of vitamin D status in populations worldwide. British Journal of Nutrition. 2014;111(1):23-45. doi: https://doi.org/10.1017/S0007114513001840

15. Karonova TL, Shmonina IA, Andreeva AT, et al. Vitamin D deficiency: the cause or the result of obesity? Consilium Medicum. 2016;18(4):49–52. (In Russ.)

16. Vimaleswaran KS, Berry DJ, Lu C, et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10(2):e1001383. doi: https://doi.org/10.1371/journal.pmed.1001383

17. Sousa-Santos AR, Afonso C, Santos A, et al. The association between 25(OH)D levels, frailty status and obesity indices in older adults. PLoS One. 2018;13(8):e0198650. doi: https://doi.org/10.1371/journal.pone.0198650

18. Pereira-Santos M, Costa PR, Assis AM, et al. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obesity Reviews. 2016;16(4):341-349. doi: https://doi.org/10.1111/obr.12239

19. Chen J, Yun C, He Y, et al. Vitamin D status among the elderly Chinese population: a cross-sectional analysis of the 2010-2013 China national nutrition and health survey (CNNHS). Nutr J. 2017;16(1):3. doi: https://doi.org/10.1186/s12937-016-0224-3

20. Alharbi AF, Ali M, Alrefaey YI, et al. Association Between Serum Vitamin D Levels and Body Mass Index Status: A Cross-Sectional Study at King Khalid Hospital, Jeddah, Saudi Arabia, From 2019 to 2020. Cureus. 2023;15(10):e46927. doi: https://doi.org/10.7759/cureus.46927

21. Głogowska-Szeląg J, Bełz A, Kajdaniuk D, et al. Relationship Between Body Mass Index-BMI and Vitamin D Concentrations in Women with Postmenopausal Osteoporosis. Current Women`s Health Reviews. 2021;17(4):316-320. doi: https://doi.org/10.2174/1573404817666210105150707

22. Kim SH, Oh JE, Song DW, et al. The factors associated with Vitamin D deficiency in community dwelling elderly in Korea. Nutr Res Pract. 2018;12(5):387-395. doi: https://doi.org/10.4162/nrp.2018.12.5.387

23. Yang L, Zhao H, Liu K, et al. Smoking behavior and circulating vitamin D levels in adults: A meta-analysis. Food Sci Nutr. 2021;9(10):5820-5832. doi: https://doi.org/10.1002/fsn3.2488.

24. Luo J, Quan Z, Lin S, Cui L. The association between blood concentration of 25- hydroxyvitamin D and sarcopenia: a meta-analysis. Asia Pac J Clin Nutr. 2018;27(6):1258-1270. doi: https://doi.org/10.6133/apjcn.201811_27(6).0013

25. Sha T, Wang Y, Zhang Y, et al. Genetic Variants, Serum 25-Hydroxyvitamin D Levels, and Sarcopenia: A Mendelian Randomization Analysis. JAMA Netw Open. 2023;6(8):e2331558. doi: https://doi.org/10.1001/jamanetworkopen.2023.31558

26. Aspell N, Laird E, Healy M, et.al. Vitamin D Deficiency Is Associated With Impaired Muscle Strength And Physical Performance In Community-Dwelling Older Adults: Findings From The English Longitudinal Study Of Ageing. Clinical Interventions in Aging. 2019;14:1751–1761. doi: https://doi.org/10.2147/CIA.S222143

27. Granic A, Hill TR, Davies K, et al. Vitamin D Status, Muscle Strength and Physical Performance Decline in Very Old Adults: A Prospective Study. Nutrients. 2017;9(4):379. doi: https://doi.org/10.3390/nu9040379

28. Mendes J, Santos A, Borges N, et.al. Vitamin D status and functional parameters: A cross-sectional study in an older population. PLoS ONE. 2018;13(8):e0201840. doi: https://doi.org/10.1371/journal.pone.0201840

29. Kim MK, Baek KH, Song KH, et al. Vitamin D deficiency is associated with sarcopenia in older Koreans, regardless of obesity: the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) 2009. J Clin Endocrinol Metab. 2011;96(10):3250–3256. doi: https://doi.org/10.1210/jc.2011-1602

30. Matheï C, Pottelbergh GV, Vaes B, et al. No relation between vitamin D status and physical performance in the oldest old: Results from the Belfrail study. Age Ageing. 2013;42:186–190. doi: https://doi.org/10.1093/ageing/afs186

31. Safonova YuA, Zotkin EG, Glazunova GM. Prevalence of vitamin D deficiency in the elderly with sarcopenia in north-west of Russia. Bulletin of St. Petersburg University. Medicine. 2019;14(1):58–68. (In Russ.). doi: https://doi.org/10.21638/11701/spbu10.2019.107

32. Jia S, Zhao W, Hu F, et al. Sex differences in the association of physical activity levels and vitamin D with obesity, sarcopenia, and sarcopenic obesity: a cross-sectional study. BMC Geriatr. 2022;22(1):898. doi: https://doi.org/10.1186/s12877-022-03577-4