Science Update

New Review Investigates the Association of Low Vitamin D Levels and Frailty in Older Adults

Aging is associated with chronic low-grade inflammation, sarcopenia and functional decline. The loss of muscle mass between the ages of 40 and 80 years is approximately between 30% to 60% and is associated with disability, illness and death.

Vitamin D is a key nutrient in musculoskeletal health. Systematic reviews and meta-analyses examined the benefits of vitamin D supplementation on physical performance, muscle mass and strength in seniors.

A new review, published 2 weeks ago in Nutrients, investigated the association of low vitamin D concentrations and frailty in older adults. This meta-analysis consisted of 13 cross-sectional studies, including 20,355 individuals >60 years of age using Fried’s criteria to identify frailty, which is classified as non-frail, pre-frail or frail. The prevalence of frailty ranged from 4% to 58% and pre-frailty was between 21% and 63%. All the studies included had more than 300 participants except for one, and they all used absolute values for vitamin D concentrations, indicating that vitamin D levels decrease as frailty severity increases. As a result, there was a significant inverse relationship between vitamin D levels and frailty severity.

The vitamin D receptor is expressed in the nucleus of muscle cells. The number of vitamin D receptors in muscle tissues and other organs declines with age.

The research team recommends daily vitamin D supplementation of 1,000 IU for improvement in skeletal muscle strength and physical performance. However, most individuals need closer to 5,000 IU to 10,000 IU of vitamin D supplementation daily. It is important to note that vitamin D is essential, but it is not the only key player. More and more research demonstrates the intricate interrelationships with other nutrients. It is important to maintain optimal levels of all fat-soluble vitamins.

Vitamin D supplementation is a cost-effective intervention that reduces falls, provides health benefits and can reduce health-care costs. Other nutrients such as magnesium, calcium, collagen and tocotrienols should be considered.

In addition, previous research has demonstrated that probiotics can significantly reduce established biomarkers of systemic inflammation in middle-age and older adults. There is evidence that age-related changes in the gut microbiome may be related to elevated inflammatory markers and other geriatric conditions, such as sarcopenia, frailty and cognitive decline secondary to reduced short chain fatty acid production. In addition, the immune system has a tendency to decline with age, which makes us more susceptible to infections, as well as increasing our risk of other diseases. Probiotics have the potential to rebalance gut microbiota and modulate gut immune response inhibiting the NF-κB pathway.

Fish oils also play a role in sarcopenia and functional decline. Their anabolic role is due to their anti-inflammatory benefits, optimization of insulin sensitivity and stimulation of muscle protein synthesis.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Marcos-Perez D, Sanchez-Flores M, Proietta S, et al. Low vitamin D levels and frailty status in older adults: a systemic review and meta-analysis. Nutrients. 2020;12(8):2286.