Anne-Marie Schott

Association of vitamin D deficiency with cognitive impairment in older women Cross-sectional study

Objective: The association between low serum 25-hydroxyvitamin D [25(OH)D] concentration and cognitive decline has been investigated by only a few studies, with mixed results. The objective of this cross-sectional population-based study was to examine the association between serum 25(OH)D deficiency and cognitive impairment while taking confounders into account. Methods: The subjects, 752 women aged ≥75 years from the Epidémiologie de lOstéoporose (EPIDOS) cohort, were divided into 2 groups according to serum 25(OH)D concentrations (either deficient, <10 ng/mL, or nondeficient, ≥10 ng/mL). Cognitive impairment was defined as a Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) score <8. Age, body mass index, number of chronic diseases, hypertension, depression, use of psychoactive drugs, education level, regular physical activity, and serum intact parathyroid hormone and calcium were used as potential confounders. Results: Compared with women with serum 25(OH)D concentrations ≥10 ng/mL (n = 623), the women with 25(OH)D deficiency (n = 129) had a lower mean SPMSQ score (p < 0.001) and more often had an SPMSQ score <8 (p = 0.006). There was no significant linear association between serum 25(OH)D concentration and SPMSQ score (β = −0.003, 95% confidence interval −0.012 to 0.006, p = 0.512). However, serum 25(OH)D deficiency was associated with cognitive impairment (crude odds ratio [OR] = 2.08 with p = 0.007; adjusted OR = 1.99 with p = 0.017 for full model; and adjusted OR = 2.03 with p = 0.012 for stepwise backward model). Conclusions: 25-Hydroxyvitamin D deficiency was associated with cognitive impairment in this cohort of community-dwelling older women.

Dietary intake of vitamin D and cognition in older women: a large population-based study.

Background: Serum vitamin D concentrations are associated with global cognitive function among older adults. The benefits of vitamin D intake to treat or prevent cognitive impairment remain unknown. The objective of this cross-sectional study was to determine whether weekly dietary intake of vitamin D could be associated with global cognitive performance among older adults. Methods: A total of 5,596 community-dwelling women (mean age 80.5 ± 0.1 years) free of vitamin D drug supplements from the Epidémiologie de lOstéoporose (EPIDOS) study were divided into 2 groups according to baseline weekly vitamin D dietary intake (either inadequate <35 μg/wk or recommended ≥35μg/wk). Weekly vitamin D dietary intakes were estimated from a self-administered food frequency questionnaire. Cognitive impairment was defined as a Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) score <8. Age, body mass index, sun exposure at midday, season, disability, number of chronic diseases, hypertension, depression, use of psychoactive drugs, and education level were considered as potential confounders. Results: Compared to women with recommended weekly vitamin D dietary intakes (n = 4,802; mean age 80.4 ± 3.8 years), women with inadequate intakes (n = 794; mean age 81.0 ± 3.8 years) had a lower mean SPMSQ score (p < 0.001) and more often had an SPMSQ score <8 (p = 0.002). We found an association between weekly vitamin D dietary intake and SPMSQ score (β = 0.002, p < 0.001). Inadequate weekly vitamin D dietary intakes were also associated with cognitive impairment (unadjusted odds ratio = 1.42 with p = 0.002; full adjusted odds ratio = 1.30 with p = 0.024). Conclusions: Weekly dietary intake of vitamin D was associated with cognitive performance in older women.

Vitamin D in the elderly: 5 points to remember

Vitamin D is a secosteroid hormone. Vitamin D receptors are present in the majority of body tissues. The manifestations of hypovitaminosis D - linked to dysfunction of target tissues - are various, including osteoporosis, cancer, tuberculosis, hypertension, multiple sclerosis, depression, dementia, sarcopenia, propensity to fall… The serum 25-hydroxyvitamin D threshold value to avoid these adverse health events is around 30u200ang/mL. Only 15% of the elderly reach this target concentration. For the remaining 85% with no supplements, the severity of hypovitaminosis D appears to be a biomarker of chronic diseases and of frailty. Conversely, the supplementation for correction of hypovitaminosis D positively impacts bone and non-bone morbidities - such as risks of falls and fractures - and reduces the mortality rate. A daily intake of at least 800-1,000u200aIU supplemental vitamin D(3) per day is the key.

Sarcopenia and cognitive impairment in elderly women: results from the EPIDOS cohort

BACKGROUNDncommon pathophysiological pathways are shared between age-related body composition changes and cognitive impairment.nnnOBJECTIVEnevaluate whether current operative sarcopenia definitions are associated with cognition in community-dwelling older women.nnnDESIGNncross-sectional analyses.nnnSUBJECTSna total of 3,025 women aged 75 years and older.nnnMEASUREMENTSnbody composition (assessed by dual energy X-ray absorptiometry) and cognition (measured by short portable mental status questionnaire) were obtained in all participants. Multivariate logistic regression models assessed the association of six operative definitions of sarcopenia with cognitive impairment. Gait speed (GS, measured over a 6-meter track at usual pace) and handgrip strength (HG, measured by a hand-held dynamometer) were considered additional factors of interest.nnnRESULTSna total of 492 (16.3%) women were cognitively impaired. The prevalence of sarcopenia ranged from 3.3 to 18.8%. No sarcopenia definition was associated with cognitive impairment after controlling for potential confounders. To proof consistency, the analyses were performed using GS and HG, two well-established predictors of cognitive impairment. Low GS [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.72-3.40] and low HG (OR: 1.81, 95% CI: 1.33-2.46) were associated with cognitive impairment.nnnCONCLUSIONnno significant association was evidenced between different operative sarcopenia definitions and cognitive impairment. The study suggests that the association between physical performance and cognitive impairment in not mediated by sarcopenia.

Defining risk thresholds for a 10-year probability of hip fracture model that combines clinical risk factors and quantitative ultrasound: results using the EPISEM cohort.

Using a large prospective cohort of over 12,000 women, we determined 2 thresholds (high risk and low risk of hip fracture) to use in a 10-yr hip fracture probability model that we had previously described, a model combining the heel stiffness index measured by quantitative ultrasound (QUS) and a set of easily determined clinical risk factors (CRFs). The model identified a higher percentage of women with fractures as high risk than a previously reported risk score that combined QUS and CRF. In addition, it categorized women in a way that was quite consistent with the categorization that occurred using dual X-ray absorptiometry (DXA) and the World Health Organization (WHO) classification system; the 2 methods identified similar percentages of women with and without fractures in each of their 3 categories, but the 2 identified only in part the same women. Nevertheless, combining our composite probability model with DXA in a case findings strategy will likely further improve the detection of women at high risk of fragility hip fracture. We conclude that the currently proposed model may be of some use as an alternative to the WHO classification criteria for osteoporosis, at least when access to DXA is limited.

Increase of vitamin D assays prescriptions and associated factors: a population-based cohort study

A worldwide increase in the frequency of testing for serum 25-hydroxyvitamin D (25OHD) levels has been observed over the last years. Our aim was to measure the evolution in the number of vitamin D assays performed in France from 2008 to 2013 and to investigate some of the drivers that may explain this increase. Patients within the representative 1/97th sample of the French health insurance system reimbursement database (EGBS database) who had at least one 25OHD or 1-25(OH)2D assay between 2008 and 2013 were included. Trends over time in number of vitamin D assays were analysed globally and per year in a multivariable Poisson regression model with GEE. Among the 639,163 patients of the EGBS database, 118,509 (18.5%) had at least one vitamin D assay over the 6-year study period. Among the individuals tested, 52.1% had only one test. The number of vitamin D assays (25OHD or 1-25(OH)2D) increased 7.5-fold from 9,620 in 2008 to 81,641 in 2013. This study confirms the rapid and dramatic increase in vitamin D assays prescriptions and shows that this is mostly due to a global increase of the proportion of patients tested rather than an increase in repetition of tests in some individual patients.