Quadriceps sarcopenia and visceral obesity are risk factors for postural instability in the middle‐aged to elderly population

Aim: Aging shifts body composition to comprising more fat and less muscle. Sarcopenia, particularly in the knee extensors, and obesity, particularly visceral obesity, either alone or in combination, may exacerbate age‐related physical disability. We investigated the association between age‐related quadriceps (Qc) sarcopenia and visceral obesity, as measured by cross‐sectional area (CSA), on postural instability. Methods: Mid‐thigh muscle CSA and abdominal visceral and subcutaneous fat area at the level of the umbilicus were assessed from computed tomography (CT) images in 410 apparently healthy independent middle‐aged to elderly subjects attending the medical check‐up program in Ehime University Hospital. Static postural instability using a posturograph and one‐leg standing time with eyes open were assessed. Results: Both abdominal visceral fat area and Qc muscle CSA corrected by body weight (BW) were associated with static postural instability, in addition to age and sex, while BW‐corrected Qc muscle CSA predicted a short one‐leg standing time. The combination of Qc sarcopenia, defined as greater than 1 standard deviation below the mean of a young group (age <60 years), and visceral obesity, defined as a visceral fat area of more than 100 cm², were associated with static postural instability, while Qc sarcopenia was related to a higher prevalence of one‐leg standing time of less than 30 s, irrespective of visceral obesity. Conclusion: Thigh Qc sarcopenia and visceral obesity are associated with postural instability in middle‐aged to elderly subjects. These findings suggest that age‐related, site‐specific fat and muscle mass alterations are associated with functional impairment. Geriatr Gerontol Int 2010; 10: 233–243.     

Association between nonspecific skeletal pain and vitamin D deficiency

Background: Deficiency of vitamin D has been reported in patients with many types of musculoskeletal pain. The present study was designed to determine the association between serum 25‐hydroxyvitamin D [25‐(OH)D] deficiency and nonspecific skeletal pain. Methods: A total of 276 patients with nonspecific skeletal pain at different regions of the skeletal system diagnosed as leg pain, widespread pain, arthralgia, rib pain, back pain and fibromyalgia were compared with 202 matched controls with regard to mean serum 25‐(OH)D level and 25‐(OH)D deficiency. Serum 25‐(OH)D was measured by enzyme‐linked immunosorbent assay method and levels < 20 ng/mL were considered as deficient. Nonparametric one‐way analysis of variance, Kruskal Wallis and Wilcoxon tests were used for group comparisons. Multiple logistic regression analysis with calculation of adjusted odds ratio (OR) and 95% confidence interval (95% CI) were performed to determine associations. Results: In patients with nonspecific skeletal pain the mean 25‐(OH)D was significantly lower (P = 0.0001) and the proportion of 25‐(OH)D deficiency was significantly higher (63.4%vs. 36.1%, P = 0.0001) compared with controls. There was a significantly positive association between 25‐(OH)D deficiency and skeletal pain (OR = 2.94, 95% CI = 1.01–4.3, P = 0.0001). The strength of association varied across the groups with strongest association observed with leg pain (OR = 7.4; 95% CI = 3.9–13.9, P = 0.0001) followed by arthralgia (OR = 3.9, 95% CI = 2.1–7.1, P = 0.0001) and widespread pain (OR = 2.8, 95% CI = 1.1–6.6, P = 0.020) but no association with back pain and fibromyalgia. There was a greater positive associations in women compared with men (OR = 2.1, 95% CI = 1.1–4.3, P = 0.001). Conclusion: The results of this study indicate a positive association of vitamin D deficiency with a variety of nonspecific bone pain, particularly in women. More studies with larger samples are required to confirm these findings. Increasing serum vitamin D to sufficient levels and longitudinal follow‐up of patients may provide further evidence in relation to vitamin D deficiency and skeletal pain.     

Obesity and vitamin D deficiency: a systematic review and meta‐analysis

Over the past decade, there have been an increasing number of studies on the association between vitamin D deficiency and anthropometric state. However, we did not identify any meta‐analyses of the relationship between obesity and vitamin D deficiency in different age groups. Thus, we evaluated the association between obesity and vitamin D deficiency. We searched for observational studies published up to April 2014 in PubMed/Medline, Web of Science and Scopus databases. We performed a meta‐analysis in accordance with the random‐effects model to obtain the summary measurement (prevalence ratio, PR). Among the 29,882 articles identified, 23 met the inclusion criteria. The prevalence of vitamin D deficiency was 35% higher in obese subjects compared to the eutrophic group (PR: 1.35; 95% CI: 1.21–1.50) and 24% higher than in the overweight group (PR: 1.24; 95% CI: 1.14–1.34). These results indicate that the prevalence of vitamin D deficiency was more elevated in obese subjects. The vitamin D deficiency was associated with obesity irrespective of age, latitude, cut‐offs to define vitamin D deficiency and the Human Development Index of the study location.     

Association between sarcopenia and mortality in healthy older people

Aim: To evaluate the association between loss of fat‐free mass and mortality among older people. Methods: Information of healthy Chilean older people evaluated by dual energy X‐ray absorptiometry was used, identifying those who died in a period of 12 years. A Cox proportional hazards model was used to identify mortality predictors. Life tables were constructed calculating survival using predictive variables. Results: Information from 1413 participants aged 74.3 ± 5.6 years (1001 women), was obtained. During the follow‐up (median 1594 days), 221 participants died. The Cox model identified age and appendicular fat‐free mass as predictors of death (hazard ratios 1.08 and 0.85, respectively). According to life tables, participants in the lower sex‐specific quartile for appendicular fat‐free mass/height had significantly higher mortality. This association was significant among participants aged over 73 years. Conclusion: A low fat‐free mass was predictive of mortality in older people.     

维生素D及其活性代谢物与糖尿病

近年的研究结果显示,维生素D不仅在调节骨和矿物质代谢中起重要作用,而且还与多种慢性疾病密切相关。基础研究发现,维生素D及其活性代谢物参与炎性反应和免疫调节过程。临床研究发现,高血压、肥胖、心血管疾病和糖尿病等现代流行病的发生与发展与维生素D及其活性代谢物有不可分割的联系。本文讨论了维生素D与糖尿病的关系以及维生素D在不同类型糖尿病的预防和治疗中的作用及机制。     

Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study

OBJECTIVES: To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex.
DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).
SETTING: Community.
PARTICIPANTS: Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli.
MEASUREMENTS: Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L.
RESULTS: The mean age±standard deviation was 75.1±7.3 for women and 73.9±6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio=1.96, 95% confidence interval=1.01–3.59) but not in men.
CONCLUSION: Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.     

Functional impact of relative versus absolute sarcopenia in healthy older women

OBJECTIVES: To determine whether adjustment of muscle mass for height² or for body mass represents a more-relevant predictor of physical performance.
DESIGN: Cross-sectional study, using baseline data from a trial comparing upper- and lower-body training.
SETTING: Women recruited from the community and gynecological practices in Connecticut.
PARTICIPANTS: One hundred eighty-nine healthy older (aged 67.5 ± 4.8), active women receiving estrogen for osteoporosis over 2 years.
MEASUREMENTS: Total and appendicular skeletal muscle (ASM) and fat mass (AFM) were determined using dual x-ray absorptiometry. Physical performance, muscle strength, and fitness measures were obtained at baseline.
RESULTS: Adjusting ASM for height² identifies lean women who are sarcopenic according to published standards yet fails to identify overweight and obese women whose ASM adjusted for body mass is low. ASM divided by body mass (ASM/body mass) is a stronger physical performance predictor, explaining 32.5%, 13.5%, 11.6%, 6.3%, and 6.8% of the variance in maximum time on treadmill, 6-minute walk, gait speed, 8-foot walk, and single leg stance, respectively, whereas ASM divided by height in m² (ASM/height²) explained only 2.9%, 0.2%, 2.0%, 0.04%, and 0.1%. Multivariate modeling demonstrated considerable overlap in aspects of ASM/body mass and AFM/body mass associated with performance, with ASM/body mass dominant. In contrast, ASM/height² is a much stronger predictor of leg press 1 repetition maximum and maximum power.
CONCLUSION: The results suggest that relative sarcopenia with ASM adjusted for body mass is a better mobility predictor, with absolute sarcopenia a better indicator of isolated muscle group function in healthy postmenopausal women receiving estrogen replacement.     

Association between vitamin D and respiratory outcomes in Canadian adolescents and adults

Background: Asthma is one of the most prevalent chronic diseases worldwide, affecting more than 200 million people. Vitamin D deficiency has been reported among individuals with asthma and might play a role in asthma exacerbations. In this cross-sectional study, we investigated the association of serum 25-hydroxy vitamin D [25(OH)D] levels and current asthma, ever asthma, and lung function. Methods: Data from 3937 subjects aged 13–69 years who participated in the Canadian Health Measures Survey – Cycle 1 were considered in this study. Serum 25(OH)D levels were categorized into ≤49?nmol/L (low), 50–74?nmol/L (moderate) and ≥75?nmol/L (high). Results: The proportion of subjects with current and ever asthma was greater in the lower 25(OH)D category than in moderate and high categories. After adjusting for potential confounders, subjects in the low 25(OH)D levels were more likely to have current asthma than those in the moderate levels (OR: 1.54, 95% CI: 1.01–2.36). Low 25(OH)D levels were also associated with ever asthma (OR: 2.12, 95% CI: 1.40–3.21) among those with a family history of asthma and this association was stronger in those with asthma onset before 20 years of age. High 25(OH)D levels were associated with lower mean value of FEV₁/FVC ratio. No significant association was observed between 25(OH)D levels and other lung function measurements. Conclusion: In this study, 25(OH)D levels below 50?nmol/L were associated with an increased risk of current and ever asthma. Further exploration of this relationship is needed to determine the optimal level of vitamin D in the management of asthma in adolescents and adults.     

Vitamin D hormone: A multitude of actions potentially influencing the physical function decline in older persons

Vitamin D, a secosteroid (pro)‐hormone, has been traditionally considered as a key regulator of bone metabolism, and calcium and phosphorous homeostasis through a negative feedback with the parathyroid hormone. However, during the last 20 years, the role played by vitamin D has been largely revised by recognizing its pleiotropic action on a wide spectrum of systems, apparatuses and tissues. Thus, vitamin D has growingly been involved as a primary determinant of biological modifications and specific clinical conditions. The effect of vitamin D on skeletal muscle and related outcomes (including physical function decline and disability) is surely one of the most relevant to study in the context of global aging. In the present review, the subclinical and clinical consequences of vitamin D deficiency/insufficiency, extremely frequent conditions in older age, are described. Special focus is given to skeletal muscle and physical function. Limitations of available scientific evidence on the topic are also discussed. Geriatr Gerontol Int 2011; 11: 133–142.     

维生素D缺乏与老年非瓣膜性心房颤动的研究

目的探讨血清25-羟维生素D水平缺乏与老年非瓣膜性心房颤动(房颤)的关系。方法选择老年患者902例,其中非瓣膜性房颤患者575例(房颤组)及窦性心律患者327例(对照组)。记录12导联心电图,测定高敏C反应蛋白(hs-CRP)、甲状旁腺激素和肝肾功能指标;化学发光分析仪测定25-羟维生素D和促甲状腺激素,心脏彩色超声检查测定LVEF、左心室收缩末期内径、左心室舒张末期内径、室间隔厚度和左心房内径,对2组各参数进行比较,并对房颤与血清25-羟维生素D水平和超声参数进行多因素逐步logistic回归分析。结果房颤组25-羟维生素D水平较对照组明显降低[(14.66±13.01)nmol/L vs (21.02±12.61)nmol/L,P=0.000];房颤组甲状旁腺激素和hs-CRP水平较对照组明显增高,差异有统计学意义(P<0.05,P<0.01)。房颤组左心房内径较对照组明显增大,差异有统计学意义(P<0.01)。多因素逐步logistic回归分析显示,房颤与血清25-羟维生素D水平呈负相关(HR=0.820,95%CI:0.768~0.900,P=0.000),与hs-CRP、左心房内径和年龄呈正相关(HR=1.127,95%CI:1.012~1.228,P=0.000;HR=2.320,95%CI:1.822~3.876,P=0.000;HR=1.150,95%CI:1.057~1.162,P=0.000)。结论维生素D缺乏与老年非瓣膜性房颤有关。     

Association between vitamin D receptor gene polymorphisms and tubular citrate handling in calcium nephrolithiasis

OBJECTIVES: Hypocitraturia is a risk factor for calcium nephrolithiasis. 1,25(OH)2D3 influences renal citrate handling and enhances citraturia. The aim of this study was to evaluate the relationship between vitamin D receptor (VDR) allelic variant and urinary citrate excretion in recurrent stone formers (SF) patients. DESIGN: Case-control study. SUBJECTS: A total of 220 recurrent calcium oxalate SF patients and 114 healthy control (C) subjects were enrolled for this study. Subjects with urinary tract infections, hyperparathyroidism, cystinuria >70 micromol/24 h, gouty diathesis, renal tubular acidosis, renal failure, chronic diarrhoeal states, intake of thiazide diuretics, angiotensin-converting enzyme (ACE)-inhibitors, glucocorticoids or oestrogens were excluded. A standard constant diet was given for 7 days. The 24-h urinary citrate excretion and the active tubular reabsorption of filtered citrate (Rcit) were evaluated. Hypocitraturia was defined as a urinary citrate excretion lower than 1.7 mmol day-1. Stone formers patients and C were genotyped for BsmI and TaqI VDR alleles. Contingency table chi-square tests were used to compare genotype frequencies in hypocitraturic SF patients, normocitraturic SF and C. RESULTS: The prevalence of hypocitraturia in SF patients was 32.7% (72 of 200). Hypocitraturia in these patients resulted from excessive Rcit of a normal load of citrate. We found a different distribution (P < 0.05) of BsmI and TaqI VDR genotypes in hypocitraturic SF patients compared with normocitraturic SF and C. In particular, the prevalence of bb and TT VDR genotypes in hypocitraturic SF was significantly higher than in normocitraturic SF and C. CONCLUSIONS: These results point to a genetic association between BsmI and TaqI VDR polymorphisms and idiopathic hypocitraturia in calcium-oxalate recurrent SF patients.     

维生素D受体基因多态性对尿毒症甲状旁腺功能的影响

目的评价维生素D受体(VDR)基因多态性对尿毒症患者继发性甲状旁腺功能亢进(SHPT)的影响.方法106例尿毒症维持性血液透析患者采用聚合酶链反应--限制性片段长度(PCR-RFLP)方法分析VDR基因Apa-Ⅰ位点多态性,有ApaⅠ酶切位点的等位基因为a,无酶切位点者定为A.结果106例患者VDR基因ApaⅠ多态性频率分别为AA17%、Aa54.7%、aa28.3%.aa基因组患者血清iPTH水平(339.8±357.4ng/L)明显高于AA基因组(151.9±167.3ng/L,P＜0.05)和Aa基因组患者(191.5±169.8ng/L,P＜0.05).aa基因组患者骨钙素水平(36.2±56.0μg/L)明显高于AA基因组(9.2±6.1μg/L,     

The prevalence of vitamin D deficiency and relationship with fracture risk in older women presenting in Australian general practice

Aim: To investigate vitamin D status among older women and to explore relationships between vitamin D and fracture risk and vertebral fractures. Methods: A total of 267 general practitioners recruited 2466 women aged >70 years with no known osteoporosis or fragility fracture. Serum 25‐hydroxy vitamin D (25(OH)D), bone mineral density by dual‐energy X‐ray absorptiometry (DXA) and vertebral fracture on thoracolumbar X‐ray were determined. Results: A total of 2368 women, median age 76 years, provided data and of these 13% were on vitamin D supplements. 25(OH)D levels were available for 907 (44.1%) of those not taking vitamin D. 88.3% of these had a level below 75 nmol/L. Serum 25(OH)D was negatively associated with age (P = 0.003) and body mass index (P < 0.001), and positively associated with lower latitude, femoral neck DXA T‐score (P = 0.044) and being Caucasian (P < 0.001). Conclusions: The vitamin D status of community‐dwelling older Australian women is inadequate, yet the use of supplements is low.     

多发孤立性浆细胞瘤伴维生素D缺乏

多发孤立性浆细胞瘤(MSP)发病率低,相关报道罕见。本文报道1例63岁女性患者,右下肢针刺样疼痛2月余,伴麻木、乏力。实验室检查提示高甲状旁腺激素血症,血清骨源性碱性磷酸酶升高,维生素D缺乏。神经肌电图显示右下肢神经源性损害。骶椎、骨盆CT增强提示骶1椎体右侧见软组织团片灶,呈膨胀性骨质破坏,骨皮质破裂。18 F-FDF PET/CT显示胸骨、胸、腰椎椎体、左侧髂骨及右侧骶骨骨质破坏影。CT引导下经皮穿刺活检免疫组化显示浆细胞骨髓瘤、CD138(+)、MUM-1(+)、Lambda(+)。结合骨髓涂片等结果该病例诊断为多发孤立性浆细胞瘤。