Serum 25-Hydroxyvitamin D and Risk of Disability in Activities of Daily Living among the Oldest-Old: An Observational and Mendelian Randomization Study

• Published in: The Journal of nutrition 2024-03, Vol.154 (3), p.1004-1013
• Main Authors: Li, Xinwei, Chen, Chen, Zhang, Yue, Wang, Jun, Cui, Xingyao, Xu, Lanjing, Zhou, Jinhui, Deng, Luojia, Zhang, Min, Lv, Yuebin, Yu, Qiong, Shi, Xiaoming
• Format: Article
• Language: English
• Subjects: 25-Hydroxyvitamin D; Activities of Daily Living; Aged; Aged, 80 and over; Aging; Biomarkers; Calcifediol; Calciferol; Cohort Studies; Disability; Female; genetic risk score; healthy aging; Humans; Mendelian randomization; Mendelian Randomization Analysis; Older people; physical disability; Randomization; Regression analysis; Regression models; Risk factors; Risk management; Risk reduction; Subgroups; Vitamin D; Vitamin D - analogs & derivatives; vitamin D deficiency; Vitamin D Deficiency - complications; Vitamin D Deficiency - genetics; Vitamin deficiency; Vitamins
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.1016/j.tjnut.2024.01.016

Vitamin D deficiency and disability are both prevalent among older adults. However, the association between them has rarely been investigated in the oldest-old subjects (aged ≥80 y), and the causality remains unclear. This study aimed to elucidate the causal effect of vitamin D on the incident risk of disability in activities of daily living (ADL) among Chinese oldest-old based on the 2012–2018 Chinese Healthy Ageing and Biomarkers Cohort Study. Serum 25-hydroxyvitamin D [25(OH)D] concentrations and ADL status at baseline and follow-up interviews were documented. Cox regression models were applied among 1427 oldest-old (mean age, 91.2 y) with normal baseline ADL status. One sample Mendelian randomization (MR) analyses were performed on a subset of 941 participants with qualified genetic data, using a 25(OH)D-associated genetic risk score as the genetic instrument. During a median follow-up of 3.4 y, 231 participants developed disability in ADL. Serum 25(OH)D concentration was inversely associated with the risk of disability in ADL [per 10 nmol/L increase hazard ratio (HR) 0.85; 95% CI: 0.75, 0.96]. Consistent results from MR analyses showed that a 10 nmol/L increment in genetically predicted 25(OH)D concentration corresponded to a 20% reduced risk of ADL disability (HR 0.80; 95% CI: 0.68, 0.94). Nonlinear MR demonstrated a monotonic declining curve, with the HRs exhibiting a more pronounced reduction among individuals with 25(OH)D concentrations below 50 nmol/L. Subgroup analyses showed that the associations were more distinct among females and those with poorer health conditions. Our study supports an inverse causal relationship between serum 25(OH)D concentration and the risk of disability in ADL among Chinese oldest-old. This protective effect was more distinct, especially for participants with vitamin D deficiency. Appropriate measures for improving vitamin D might help reduce the incidence of physical disability in this specific age group.