Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Measurement of Outcome
2.3. Measurement of Exposure
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Characteristics of Individuals at Baseline
3.2. Vitamin D Status and Risk of Incidence of IADL Disability
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Da Silva Alexandre, T.; Corona, L.P.; Nunes, D.P.; Santos, J.L.F.; de Oliveira Duart, Y.A.; Lebrão, M.L. Disability in Instrumental Activities of Daily Living among Older Adults: Gender Differences. Rev. Saúde Pública 2014, 48, 379–389. [Google Scholar] [CrossRef] [PubMed]
- Chiu, H.-C.; Mau, L.-W.; Tasi, W.-L.; Hsieh, Y.-H.; Liu, H.-W. Chronic Medical Conditions as Predictors of Functional Disability in an Older Population in Taiwan. Australas J. Ageing 2004, 23, 19–24. [Google Scholar] [CrossRef]
- Inzitari, M.; Doets, E.; Bartali, B.; Benetou, V.; Di Bari, M.; Visser, M.; Volpato, S.; Gambassi, G.; Topinkova, E.; De Groot, L.; et al. Nutrition in the Age-Related Disablement Process. J. Nutr. Health Aging 2011, 15, 599–604. [Google Scholar] [CrossRef] [Green Version]
- Cashman, K.D. Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing. Calcif. Tissue Int. 2020, 106, 14–29. [Google Scholar] [CrossRef] [PubMed]
- Amrein, K.; Scherkl, M.; Hoffmann, M.; Neuwersch-Sommeregger, S.; Köstenberger, M.; Tmava Berisha, A.; Martucci, G.; Pilz, S.; Malle, O. Vitamin D Deficiency 2.0: An Update on the Current Status Worldwide. Eur. J. Clin. Nutr. 2020, 74, 1498–1513. [Google Scholar] [CrossRef] [PubMed]
- Need, A.G.; Morris, H.A.; Horowitz, M.; Nordin, C. Effects of Skin Thickness, Age, Body Fat, and Sunlight on Serum 25-Hydroxyvitamin D. Am. J. Clin. Nutr. 1993, 58, 882–885. [Google Scholar] [CrossRef] [PubMed]
- Gallagher, J.C. Vitamin D and Aging. Endocrinol. Metab. Clin. N. Am. 2013, 42, 319–332. [Google Scholar] [CrossRef] [Green Version]
- Laird, E.; O’Halloran, A.M.; Carey, D.; Healy, M.; O’Connor, D.; Moore, P.; Shannon, T.; Molloy, A.M.; Kenny, R.A. The Prevalence of Vitamin D Deficiency and the Determinants of 25(OH)D Concentration in Older Irish Adults: Data From The Irish Longitudinal Study on Ageing (TILDA). J. Gerontol. A Biol. Sci. Med. 2018, 73, 519–525. [Google Scholar] [CrossRef]
- Holick, M.F. Vitamin D: A D-Lightful Solution for Health. J. Investig. Med. 2011, 59, 872–880. [Google Scholar] [CrossRef]
- Zamboni, M.; Zoico, E.; Tosoni, P.; Zivelonghi, A.; Bortolani, A.; Maggi, S.; Di Francesco, V.; Bosello, O. Relation Between Vitamin D, Physical Performance, and Disability in Elderly Persons. J. Gerontol. A Biol. Sci. Med. 2002, 57, M7–M11. [Google Scholar] [CrossRef] [Green Version]
- Houston, D.K.; Tooze, J.A.; Davis, C.C.; Chaves, P.H.M.; Hirsch, C.H.; Robbins, J.A.; Arnold, A.M.; Newman, A.B.; Kritchevsky, S.B. Serum 25-Hydroxyvitamin D and Physical Function in Older Adults: The Cardiovascular Health Study All Stars. J. Am. Geriatr. Soc. 2011, 59, 1793–1801. [Google Scholar] [CrossRef] [PubMed]
- Wagatsuma, A.; Sakuma, K. Vitamin D Signaling in Myogenesis: Potential for Treatment of Sarcopenia. BioMed Res. Int. 2014, 2014, 121254. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Visser, M.; Deeg, D.J.H.; Lips, P. Low Vitamin D and High Parathyroid Hormone Levels as Determinants of Loss of Muscle Strength and Muscle Mass (Sarcopenia): The Longitudinal Aging Study Amsterdam. J. Clin. Endocrinol. Metab. 2003, 88, 5766–5772. [Google Scholar] [CrossRef]
- Groves, N.; Burne, T.H.J. The Impact of Vitamin D Deficiency on Neurogenesis in the Adult Brain. Neural. Regen. Res. 2017, 12, 393. [Google Scholar] [CrossRef] [PubMed]
- Leveille, S.G.; Resnick, H.E.; Balfour, J. Gender Differences in Disability: Evidence and Underlying Reasons. Aging Clin. Exp. Res. 2000, 12, 106–112. [Google Scholar] [CrossRef]
- Maggio, D.; Cherubini, A.; Lauretani, F.; Russo, R.C.; Bartali, B.; Pierandrei, M.; Ruggiero, C.; Macchiarulo, M.C.; Giorgino, R.; Minisola, S.; et al. 25(OH)D Serum Levels Decline With Age Earlier in Women Than in Men and Less Efficiently Prevent Compensatory Hyperparathyroidism in Older Adults. J. Gerontol. A Biol. Sci. Med. 2005, 60, 1414–1419. [Google Scholar] [CrossRef]
- Alekna, V.; Kilaite, J.; Mastaviciute, A.; Tamulaitiene, M. Vitamin D Level and Activities of Daily Living in Octogenarians: Cross-Sectional Study. Front. Endocrinol. 2018, 9, 326. [Google Scholar] [CrossRef]
- Tanabe, S.; Yano, S.; Mishima, S.; Nagai, A. Physical Inactivity and Vitamin D Deficiency in Hospitalized Elderlies. J. Bone Min. Metab. 2019, 37, 928–934. [Google Scholar] [CrossRef]
- Kotlarczyk, M.P.; Perera, S.; Ferchak, M.A.; Nace, D.A.; Resnick, N.M.; Greenspan, S.L. Vitamin D Deficiency Is Associated with Functional Decline and Falls in Frail Elderly Women despite Supplementation. Osteoporos. Int. 2017, 28, 1347–1353. [Google Scholar] [CrossRef]
- Hakeem, S.; Mendonca, N.; Aspray, T.; Kingston, A.; Ruiz-Martin, C.; Jagger, C.; Mathers, J.C.; Duncan, R.; Hill, T.R. The Association between 25-Hydroxyvitamin D Concentration and Disability Trajectories in Very Old Adults: The Newcastle 85+ Study. Nutrients 2020, 12, 2742. [Google Scholar] [CrossRef]
- Mindell, J.; Biddulph, J.P.; Hirani, V.; Stamatakis, E.; Craig, R.; Nunn, S.; Shelton, N. Cohort Profile: The Health Survey for England. Int. J. Epidemiol. 2012, 41, 1585–1593. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Steptoe, A.; Breeze, E.; Banks, J.; Nazroo, J. Cohort Profile: The English Longitudinal Study of Ageing. Int. J. Epidemiol. 2013, 42, 1640–1648. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Banks, J.; Nazroo, J.; Steptoe, A. The Institute for Fiscal Studies. The dynamics of ageing: Evidence from the English Longitudinal Study of Ageing 2002–2012 (Wave 6); The Institute for Fiscal Studies: London, UK, 2014; Available online: https://www.ifs.org.uk/uploads/elsa/docs_w6/ELSA%20Wave%206%20report.pdf (accessed on 9 June 2020).
- Lawton, M.P.; Brody, E.M. Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. Gerontologist 1969, 9, 8. [Google Scholar] [CrossRef]
- Luiz, M.M.; Máximo, R.; Oliveira, D.C.; Ramírez, P.C.; de Souza, A.F.; Delinocente, M.L.B.; Steptoe, A.; de Oliveira, C.; Alexandre, T. Association of Serum 25-Hydroxyvitamin D Deficiency with Risk of Incidence of Disability in Basic Activities of Daily Living in Adults > 50 years of Age. J. Nutr. 2020, 150, 2977–2984. [Google Scholar] [CrossRef] [PubMed]
- Dietary Reference Intakes: Calcium, Vitamin D; Ross, A.C.; Institute of Medicine (U.S.) (Eds.) National Academies Press: Washington, DC, USA, 2011; ISBN 978-0-309-16394-1. [Google Scholar]
- Craig, R.; Mindell, J.; Hirani, V.; Joint Health Surveys Unit (Great Britain); Great Britain; National Health Service; Information Centre; National Centre for Social Research (Great Britain). Health Survey for England 2008: Physical Activity and Fitness; National Centre for Social Research with Permission of The NHS Information Centre: London, UK, 2009; ISBN 978-1-904599-95-1. [Google Scholar]
- Radloff, L.S. The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Appl. Psychol. Meas. 1977, 1, 385–401. [Google Scholar] [CrossRef]
- Ofstedal, M.B.; Fisher, G. Documentation of Cognitive Functioning Measures in the Health and Retirement Study; Institute for Social Research, University of Michigan: Ann Arbor, MI, USA, 2005. [Google Scholar]
- Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation; World Health Organization (Ed.) WHO Technical Report Series; World Health Organization: Geneva, Switzerland, 2000; ISBN 978-92-4-120894-9. [Google Scholar]
- Alley, D.E.; Shardell, M.D.; Peters, K.W.; McLean, R.R.; Dam, T.-T.L.; Kenny, A.M.; Fragala, M.S.; Harris, T.B.; Kiel, D.P.; Guralnik, J.M.; et al. Grip Strength Cutpoints for the Identification of Clinically Relevant Weakness. J. Gerontol. A Biol. Sci. Med. 2014, 69, 559–566. [Google Scholar] [CrossRef]
- Gröber, U.; Kisters, K. Influence of Drugs on Vitamin D and Calcium Metabolism. Dermatoendocrinology 2012, 4, 158–166. [Google Scholar] [CrossRef] [Green Version]
- Zou, G. A Modified Poisson Regression Approach to Prospective Studies with Binary Data. Am. J. Epidemiol. 2004, 159, 702–706. [Google Scholar] [CrossRef]
- Maldonado, G.; Greenland, S. Simulation Study of Confounder-Selection Strategies. Am. J. Epidemiol. 1993, 138, 923–936. [Google Scholar] [CrossRef] [Green Version]
- Sohl, E.; van Schoor, N.M.; de Jongh, R.T.; Visser, M.; Deeg, D.J.H.; Lips, P. Vitamin D Status Is Associated With Functional Limitations and Functional Decline in Older Individuals. J. Clin. Endocrinol. Metab. 2013, 98, E1483–E1490. [Google Scholar] [CrossRef]
- Li, F.-R.; Chen, P.-L.; Lv, Y.-B.; Cheng, X.; Yang, H.-L.; Yin, Z.-X.; Zhao, F.; Zhang, X.-R.; Li, Z.-H.; Shen, D.; et al. Association Between Plasma 25-Hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study. J. Am. Med. Dir. Assoc. 2020, 22, 1946–1952. [Google Scholar] [CrossRef] [PubMed]
- Bleijenberg, N.; Zuithoff, N.P.A.; Smith, A.K.; de Wit, N.J.; Schuurmans, M.J. Disability in the Individual ADL, IADL, and Mobility among Older Adults: A Prospective Cohort Study. J. Nutr. Health Aging 2017, 21, 897–903. [Google Scholar] [CrossRef] [PubMed]
- Houston, D.K.; Neiberg, R.H.; Tooze, J.A.; Hausman, D.B.; Johnson, M.A.; Cauley, J.A.; Bauer, D.C.; Shea, M.K.; Schwartz, G.G.; Williamson, J.D.; et al. Low 25-Hydroxyvitamin D Predicts the Onset of Mobility Limitation and Disability in Community-Dwelling Older Adults: The Health ABC Study. J. Gerontol. A Biol. Sci. Med. 2013, 68, 181–187. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Toffanello, E.D.; Coin, A.; Perissinotto, E.; Zambon, S.; Sarti, S.; Veronese, N.; De Rui, M.; Bolzetta, F.; Corti, M.-C.; Crepaldi, G.; et al. Vitamin D Deficiency Predicts Cognitive Decline in Older Men and Women: The Pro.V.A. Study. Neurology 2014, 83, 2292–2298. [Google Scholar] [CrossRef] [PubMed]
- McPhee, J.S.; Cameron, J.; Maden-Wilkinson, T.; Piasecki, M.; Yap, M.H.; Jones, D.A.; Degens, H. The Contributions of Fiber Atrophy, Fiber Loss, In Situ Specific Force, and Voluntary Activation to Weakness in Sarcopenia. J. Gerontol. A Biol. Sci. Med. 2018, 73, 1287–1294. [Google Scholar] [CrossRef] [PubMed]
- Doherty, T.J. The Influence of Aging and Sex on Skeletal Muscle Mass and Strength. Curr. Opin. Clin. Nutr. Metab. Care 2001, 4, 503–508. [Google Scholar] [CrossRef]
- Holt, R.; Juel Mortensen, L.; Harpelunde Poulsen, K.; Nielsen, J.E.; Frederiksen, H.; Jørgensen, N.; Jørgensen, A.; Juul, A.; Blomberg Jensen, M. Vitamin D and Sex Steroid Production in Men with Normal or Impaired Leydig Cell Function. J. Steroid Biochem. Mol. Biol. 2020, 199, 105589. [Google Scholar] [CrossRef]
- Gouras, G.K.; Xu, H.; Gross, R.S.; Greenfield, J.P.; Hai, B.; Wang, R.; Greengard, P. Testosterone Reduces Neuronal Secretion of Alzheimer’s β-Amyloid Peptides. Proc. Natl. Acad. Sci. USA 2000, 97, 1202–1205. [Google Scholar] [CrossRef] [Green Version]
- Maggio, M.; Dall’Aglio, E.; Lauretani, F.; Cattabiani, C.; Ceresini, G.; Caffarra, P.; Valenti, G.; Volpi, R.; Vignali, A.; Schiavi, G.; et al. The Hormonal Pathway to Cognitive Impairment in Older Men. J. Nutr. Health Aging 2012, 16, 40–54. [Google Scholar] [CrossRef]
Total (n = 4768) | Serum 25-Hydroxyvitamin D Concentrations | |||
---|---|---|---|---|
>50 nmol/L (n = 2135) | >30 to ≤50 nmol/L (n = 1543) | ≤30 nmol/L (n = 1090) | ||
Age, years (SD) | 66.0 ± 8.5 | 66.1 ± 8.2 | 66.1 ± 8.6 | 65.7 ± 9.0 |
50–59 | 24.8 | 23.1 | 24.1 | 29.1 ** |
60–69 | 42.6 | 44.4 | 42.5 | 39.4 * |
70–79 | 25.8 | 26.5 | 26.1 | 23.9 |
80–89 | 6.4 | 5.7 | 7.0 | 7.1 |
≥90 | 0.4 | 0.3 | 0.3 | 0.5 |
Sex (women) % | 53.1 | 52.5 | 51.4 | 56.7 |
Race (non-white) % | 2.7 | 1.1 | 2.5 * | 6.1 ** |
Conjugal life (yes) % | 69.4 | 74.1 | 67.6 * | 62.6 * |
Schooling, % | ||||
>13 years | 35.4 | 36.4 | 35.7 | 33.0 |
12 to 13 years | 28.9 | 28.9 | 29.6 | 27.8 |
≤11 years | 35.7 | 34.7 | 34.7 | 39.2 |
Wealth, % | ||||
Upper quintile | 25.1 | 29.1 | 24.6 * | 18.2 ** |
4° quintile | 22.8 | 24.3 | 23.5 | 19.0 ** |
3° quintile | 21.0 | 22.2 | 20.3 | 19.8 |
2° quintile | 17.6 | 14.8 | 17.8 | 22.8 ** |
Lower quintile | 11.4 | 7.9 | 11.4 * | 18.1 ** |
Not applicable | 2.1 | 1.7 | 2.4 | 2.1 |
Smoking, % | ||||
Non-smoker | 39.9 | 40.3 | 40.8 | 37.9 |
Former smoker | 49.5 | 52.4 | 49.1 | 44.4 * |
Current smoker | 10.6 | 7.3 | 10.1 * | 17.7 ** |
Alcohol intake, % | ||||
Rarely/never | 16.3 | 13.0 | 16.5 * | 22.4 ** |
Frequently | 40.8 | 41.6 | 42.1 | 37.5 |
Daily | 35.6 | 40.5 | 33.6 * | 29.1 * |
Not applicable | 7.3 | 4.9 | 7.8 * | 11.0 * |
Physical activity (sedentary), % | 1.9 | 1.5 | 1.7 | 3.0 |
Total (n = 4768) | Serum 25-Hydroxyvitamin D Concentrations | |||
---|---|---|---|---|
>50 nmol/L (n = 2135) | >30 to ≤50 nmol/L (n = 1543) | ≤30 nmol/L (n = 1090) | ||
Health conditions, % | ||||
Hypertension | 34.8 | 32.4 | 35.9 | 37.9 ** |
Diabetes mellitus | 8.2 | 7.3 | 8.7 | 9.4 |
Cancer | 2.5 | 5.5 | 3.9 | 4.2 |
Heart disease | 13.6 | 13.7 | 13.8 | 13.0 |
Lung disease | 11.9 | 11.6 | 11.8 | 12.6 |
Stroke | 2.7 | 2.2 | 2.5 | 3.8 |
Osteoporosis | 6.6 | 8.8 | 5.6 * | 3.7 * |
Osteoarthritis | 33.9 | 33.5 | 33.4 | 35.4 |
Dementia | 0.3 | 0.2 | 0.2 | 0.5 |
Falls | 18.0 | 18.6 | 18.9 | 15.5 |
Depressive symptoms | 8.3 | 6.7 | 7.8 | 12.2 ** |
Memory (SD) | 11.3 ± 3.3 | 11.5 ± 3.3 | 11.2 ± 3.3 | 11.1 ± 3.7 * |
Seasonality, % | ||||
Spring | 22.7 | 30.9 | 20.5 * | 9.6 ** |
Summer | 8.1 | 5.2 | 7.9 * | 13.9 ** |
Autumn | 42.5 | 46.2 | 44.8 | 32.2 ** |
Winter | 26.7 | 17.7 | 26.8 * | 44.3 ** |
Vitamin D supplementation, % | 4.5 | 4.6 | 4.5 | 4.0 |
Use of carbamazepine, % | 1.9 | 1.9 | 2.0 | 1.7 |
WC, cm (SD) | 95.4 ± 18.6 | 93.7 ± 23.3 | 96.4 ± 13.2 * | 97.3 ± 14.3 * |
>102 men >88 women % | 48.2 | 41.7 | 51.2 * | 56.7 ** |
BMI, kg/m2 (SD) | 27.8 ± 4.8 | 27.1 ± 4.3 | 28.2 ± 4.8 * | 28.7 ± 5.4 * |
≥18.5 and <25 kg/m2 | 28.3 | 32.3 | 25.4 * | 24.4 * |
<18.5 kg/m2 | 0.8 | 1.0 | 0.4 | 1.2 |
≥25 and <30 kg/m | 43.3 | 45.3 | 43.7 | 39.0 * |
≥30 kg/m | 27.6 | 21.4 | 30.5 * | 35.4 * |
Grip strength, kg (SD) | 32.0 ± 11.4 | 32.3 ± 11.3 | 32.2 ± 11.3 | 31.2 ± 11.4 |
<26 men <16 women % | 6.2 | 5.9 | 6.2 | 7.0 |
25(OH)D Status | IRR for Incidence of Disability in IADL | |
---|---|---|
Men 1 (n = 1887) | Women 2 (n = 2165) | |
Sufficient (>50 nmol/L) | 1.00 | 1.00 |
Insufficient (>30 to ≤50 nmol/L) | 1.02 [0.76–1.38] | 1.19 [0.93–1.53] |
Deficient (≤30 nmol/L) | 1.43 [1.02–2.00] | 1.23 [0.94–1.62] |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Luiz, M.M.; Máximo, R.d.O.; de Oliveira, D.C.; Ramírez, P.C.; de Souza, A.F.; Delinocente, M.L.B.; Steptoe, A.; de Oliveira, C.; Alexandre, T.d.S. Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study. Nutrients 2022, 14, 2012. https://doi.org/10.3390/nu14102012
Luiz MM, Máximo RdO, de Oliveira DC, Ramírez PC, de Souza AF, Delinocente MLB, Steptoe A, de Oliveira C, Alexandre TdS. Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study. Nutrients. 2022; 14(10):2012. https://doi.org/10.3390/nu14102012
Chicago/Turabian StyleLuiz, Mariane Marques, Roberta de Oliveira Máximo, Dayane Capra de Oliveira, Paula Camila Ramírez, Aline Fernanda de Souza, Maicon Luís Bicigo Delinocente, Andrew Steptoe, Cesar de Oliveira, and Tiago da Silva Alexandre. 2022. "Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study" Nutrients 14, no. 10: 2012. https://doi.org/10.3390/nu14102012
APA StyleLuiz, M. M., Máximo, R. d. O., de Oliveira, D. C., Ramírez, P. C., de Souza, A. F., Delinocente, M. L. B., Steptoe, A., de Oliveira, C., & Alexandre, T. d. S. (2022). Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study. Nutrients, 14(10), 2012. https://doi.org/10.3390/nu14102012