Dietary and supplemental antioxidant intake and risk of major adverse cardiovascular events in older men: The concord health and ageing in men project.

BACKGROUND AND AIMS: The role of antioxidant intake in cardiovascular disease remains inconclusive. This study evaluates the association between antioxidant intake and the risk of major adverse cardiovascular events (MACE) among older Australian men. METHODS AND RESULTS: 794 men aged ≥75 years participated in the 3rd wave of the Concord Health and Ageing in Men Project. Dietary adequacy of antioxidant intake was assessed by comparing participants' intake of vitamins A, E, C and zinc to the Nutrient Reference Values (NRV) for Australia. Attainment of NRVs of antioxidants was categorised into a dichotomised variable 'inadequate' (meeting≤2 of 4 antioxidants) or 'adequate' (meeting≥3 of 4 antioxidants). The usage of antioxidant supplements was assessed. The outcome measure was MACE. The composite MACE endpoint was defined as having one of the following: death, myocardial infarction, ischemic stroke, congestive cardiac failure (CCF), and revascularization during the period of observation. There was no significant association between dietary (HR: 1.03, 95% CI: 0.71, 1.48) or supplemental antioxidant intake (HR: 1.10, 95% CI: 0.75, 1.63) and overall MACE. However, a significant association was observed between inadequate antioxidant intake and CCF (HR: 1.32; 95% CI: 1.16, 1.50). The lowest quartile of zinc intake (<11.00 mg/d) was significantly associated with CCF (HR 2.36; 95% CI: 1.04, 5.34). None of the other antioxidants were significantly associated with CCF or other MACE components. CONCLUSION: Inadequate dietary antioxidant intake, particularly zinc, is associated with increased risk of CCF in older Australian men but not associated with overall MACE.

Dietary or supplemental intake of antioxidants and the risk of mortality in older people: A systematic review.

PURPOSE: Antioxidants have a protective role in the prevention of cancer, cardiovascular disease and all-cause mortality. The association between dietary or supplemental intake of various antioxidants and all-cause mortality or cause-specific mortality among older populations is inconclusive. This systematic review aimed to systematically evaluate whether higher dietary or supplemental intake of antioxidants can lower the risk of all-cause mortality or cause-specific mortality in the older population. METHODS: Five electronic databases were searched to identify studies that evaluated the effects of dietary or supplemental intake of antioxidants on cause-specific or all-cause mortality in the older population aged ≥65 years. The overall quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Twenty-two longitudinal, prospective observational studies and randomised controlled trial (RCT) studies involving 1 090 844 cases of cause-specific and all-cause mortality were included. The overall quality of studies was high with a low risk of bias. RESULT: Of the 22 studies, 16 were observational studies and 6 were RCTs. The overall quality of evidence for observational studies and RCTs were rated down as low (due to very serious risk of bias and indirectness) and moderate (due to unable to rule out publication bias), respectively. Nine studies showed significant decreases, four found significant increases and nine reported no association between antioxidant intake and risk of mortality. CONCLUSION: There was inconclusive evidence on the associations between dietary or supplemental intake of antioxidants and mortality in the older population. More clinical trials are required to confirm the associations.

Prospective Associations Between Dietary Antioxidant Intake and Frailty in Older Australian Men: The Concord Health and Ageing in Men Project.

BACKGROUND: The objective of the study is to evaluate the prospective associations between antioxidant intake and incident frailty among older Australian men aged ≥75 years. METHODS: Seven hundred and ninety-four men participated in a detailed diet history interview at the Concord Health and Ageing in Men Project (CHAMP) study third wave (considered baseline nutrition here) and 781 men participated at the fourth wave (considered 3-year follow-up here). The main outcome measurement was incident frailty at 3-year follow-up, using the Cardiovascular Health Study definition. Dietary adequacy of antioxidant intake was assessed by comparing participants' median intakes of four dietary antioxidants (vitamin A, E, C, and zinc) to the nutrient reference values (NRVs). Attainment of the NRVs was incorporated into a dichotomized variable "poor" (meeting ≤2 antioxidants) or "good" (meeting ≥3 antioxidants) as the independent variable using the cut-point method. Also, intakes of each individual dietary antioxidant at baseline nutrition were categorized into quartiles. Analyses were performed using multinomial logistic regression. RESULTS: Incidence of pre-frailty was 53.0% and frailty was 6.4% at 3-year follow-up. Poor dietary antioxidant intake (meeting ≤2) at baseline nutrition was associated with incident frailty at 3-year follow-up in unadjusted (OR: 2.59 [95% CI: 1.47, 4.59, p = .001]) and adjusted (OR: 2.46 [95% CI: 1.10, 5.51, p = .03]) analyses. The lowest quartile of vitamin E intake (<7.08 mg/d) was significantly associated with incident frailty (OR: 2.46 [95% CI: 1.01, 6.00, p = .05]). CONCLUSIONS: Poor antioxidant intake, particularly vitamin E, is a plausible factor associated with incident frailty among older men. This supports the need for clinical trials of diets rich in antioxidants or possibly low-dose antioxidant supplements, for prevention of frailty.

Systematic review and meta-analysis of the effect of protein and amino acid supplements in older adults with acute or chronic conditions.

The loss of lean body mass, muscle strength and physical function causes significant problems in older adults. Protein and amino acid supplements can preserve muscle strength but the effect on function is variable. We conducted a systematic literature review and meta-analysis to investigate the effect of protein and amino acid supplementation on fat-free mass, muscle strength and physical function in malnourished, frail, sarcopenic, dependent or elderly with acute or chronic conditions, with or without rehabilitation exercise. Databases searched included Medline, BIOSIS, CINAHL, Cochrane Library, EBM Reviews, Embase, Pre-Medline, ProQuest, PubMed and Scopus. Retrieved articles were assessed by two reviewers using the Cochrane Risk of Bias (ROB) Tool. In all, thirty nine randomised controlled trails (n 4274) were included. The studies used a range of protein or essential amino acid (EAA) supplements in a variety of settings, including hospital, community and long-term care. Only seven studies had low ROB and no effect of supplementation was found on any outcomes. Analysis of all thirty-nine studies suggest protein and EAA supplements may improve fat-free mass, muscle strength and physical function (standardised mean difference 0·21-0·27, all P<0·005), but significant heterogeneity and ROB was evident. Predetermined subgroup analysis found undernourished elderly benefitted most; EAA were the most effective supplements and small beneficial effects were seen without rehabilitation exercise. The high heterogeneity and few studies with low ROB limits the conclusions and more high quality studies are needed to determine the best nutritional strategies for the maintenance of strength and function with increasing age.

Longitudinal Associations Between Vitamin D Metabolites and Sarcopenia in Older Australian men: The Concord Health and Aging in Men Project.

BACKGROUND: To explore the associations between serum 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) levels at baseline and incidence of sarcopenia over time in older Australian community-dwelling older men. METHODS: Of the 1,705 men aged ≥70 years (2005-2007) participating in the Concord Health and Ageing in Men Project, those without sarcopenia at baseline (n = 1,312 for 25D and n = 1,231 for 1,25D), 2 years (n = 1,024 for 25D and n = 956 for 1,25D), and 5-year follow-up (n = 709 for 25D and n = 663 for 1,25D) were included in the study. The main outcome measurement was the incidence of sarcopenia defined as appendicular lean mass adjusted for body mass index <0.789 and grip strength <26.0 kg. Serum 25D and 1,25D levels were measured at baseline by radioimmunoassay (Diasorin, Stillwater, MN) and categorized into quartiles as predictor variables. Covariates included age, income, season of blood collection, physical activity, vitamin D supplement and medication use, measures of health, serum parathyroid hormone (PTH), estimated glomerular filtration rate (eGFR), albumin, and white blood cell count. RESULTS: In this study, incidence of sarcopenia was 3.9% in men at the 2-year follow-up and 8.6% at the 5-year follow-up. In adjusted analysis, men with vitamin D levels in the lowest quartiles (25D <40nmol/L; 1,25D <62 pmol/L) showed significant associations with increased odds of incident sarcopenia compared to those with vitamin D levels in the highest quartiles over 5 years. [25D: odds ratio (OR) 2.53 (95% confidence interval (CI) 1.14, 5.64) p = .02; 1,25D: OR 2.67 (95% CI 1.28, 5.60) p = .01]. After further adjustments for the respective other serum vitamin D measure, (either 25D or 1,25D), the association remained significant [25D: OR 2.40 (95% CI 1.02, 5.64) p = .04; 1,25D: OR 2.23 (95% CI 1.04, 4.80) p = .04]. CONCLUSION: Low serum 1,25D and 25D concentrations at baseline are independently associated with the incidence of sarcopenia over the subsequent 5 years. Although our data do not prove any causal relationship, it is conceivable that maintaining vitamin D sufficiency may reduce the incidence of sarcopenia in ageing men.

Low levels of 25-hydroxy vitamin D and active 1,25-dihydroxyvitamin D independently associated with type 2 diabetes mellitus in older Australian men: the Concord Health and Ageing in Men Project.

OBJECTIVES: To examine the associations between serum 25-hydroxyvitamin D (25OHD) levels and the active vitamin D metabolite, 1,25-hydroxyvitamin D (1,25OHD), with type 2 diabetes mellitus (DM) in community-living men aged 70 and older. DESIGN: Cross-sectional. SETTING: A population-based, cross-sectional analysis of the baseline phase of the Concord Health and Ageing in Men Project (CHAMP), a large epidemiological study conducted in Sydney between January 2005 and May 2007. PARTICIPANTS: Community dwelling men aged 70 and older taking part in CHAMP (N = 1,659). MEASUREMENTS: Serum 25OHD and 1,25OHD levels, presence of DM, age, country of birth, season of blood collection, sun exposure, body mass index, vitamin D supplement use, statin use, income, measures of health, depression, activity of daily living disabilities, parathyroid hormone, estimated glomerular filtration rate, phosphate, and calcium. RESULTS: The prevalence of DM was 20.0%. There was a significant association between low 25OHD and 1,25OHD levels and DM that remained after adjustment for a wide range of confounders and covariates of clinical significance such as comorbidity, renal function, calciotropic hormones, and medications. CONCLUSION: 25OHD and 1,25OHD levels were associated with DM. The independent association between serum 25OHD and 1,25OHD concentrations and DM raises the question of whether each of the two vitamin D metabolites may influence DM through different biological mechanisms and pathways.

Associations between vitamin D and self-reported respiratory disease in older people from a nationally representative population survey.

OBJECTIVES: To investigate the association between serum 25-hydroxy vitamin D (25(OH)D) concentrations and respiratory diseases in older people. DESIGN: Cross-sectional, nationally representative sample. SETTING: Community. PARTICIPANTS: Two thousand seventy noninstitutionalized adults aged 65 and older taking part in the Health Survey for England 2005. MEASUREMENTS: Serum 25(OH)D levels, self-reported long-term respiratory tract diseases, and covariates (age, sex, social class, season of examination, use of vitamin supplements, and physical health status). RESULTS: Participants with severe deficiency (25(OH)D < 35 nmol/L) had more than twice the risk of respiratory disease than those in the highest quartile of 25(OH)D status (>64 nmol/L), and those with moderate deficiency (second quartile: 25(OH)D 35-48.9 nmol/L) had 1.75 times greater odds of respiratory diseases, even after adjustment with covariates. Adjusted analysis showed that those in the third quartile (25(OH)D 49.0 to 63.9 nmol/L) also had a greater risk of respiratory disease (odds ratio = 1.63, 95% confidence interval = 1.04-2.57). CONCLUSION: Low serum 25(OH)D concentrations are associated with respiratory disease. Ensuring adequate 25(OH)D levels is of public health importance for older populations living in northern latitudes and may be an effective way to prevent concurrent respiratory infections and related complications in older people. Further studies are required to investigate whether vitamin D supplementation may reduce the incidence and exacerbations of respiratory disease.

Associations between frailty and serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations in older Australian men: the Concord Health and Ageing in Men Project.

BACKGROUND: Poor vitamin D status and frailty are common in older people and associated with adverse health outcomes. The aim of this study was to examine the associations between serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and frailty and components of frailty in older Australian men. METHODS: Cross-sectional analysis of the Concord Health and Ageing in Men Project, a large epidemiological study conducted in Sydney, Australia, between January 2005 and May 2007. Participants included 1,659 community-dwelling men. Main outcome measurements were frailty (assessed using the Cardiovascular Health Study), frailty criteria comprising five core components: weight loss; reduced muscular strength/weakness; slow walking speed; exhaustion; and low activity level, and the separate components of frailty. Covariates included serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels measured by radioimmunoassay, age, country of birth, season of blood collection, sun exposure, body mass index, vitamin D supplement use, income, measures of health, parathyroid hormone, estimated glomerular function. RESULTS: Frailty was present in 9.2% of the sample. Low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were independently associated with frailty and with four of the five components of frailty (except weight loss). CONCLUSIONS: 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D levels were independently associated with frailty in older men. This suggests that there might be a number of different biological mechanisms for how low vitamin D status might contribute to the frailty syndrome. In addition, the possibility that improving vitamin D status may specifically influence the incidence and progression of frailty needs to be explored.

Vitamin D status and pain: analysis from the Health Survey for England among English adults aged 65 years and over.

Poor vitamin D status is common in older people and results in osteoporosis; osteomalacia is associated with a wide range of non-communicable diseases and has potential effects on poor health outcomes. Pain is also common in older people and can be substantially disabling. The aim of the present analysis is to investigate associations between serum 25-hydroxy vitamin D (25(OH)D) and self-reported current symptoms of pain in a cross-sectional, nationally representative sample of 2070 adults aged ≥ 65 years living in the community in England in 2005. Measurements included serum 25(OH)D, pain status and covariates, namely, age, sex, social class, season of examination, use of vitamin supplements and physical health status. Results show that the symptoms of moderate/extreme pain (present in 53 % of the sample) were associated with poor vitamin D status, independent of other covariates. Particular advantages of the present study were the presence of directly measured vitamin D levels and a large and nationally representative sample. Poor vitamin D status is common and an associated risk factor for pain in older people living in northern latitudes. The direction of causation cannot be inferred from a cross-sectional study and further prospective research is required to clarify this. Regardless of the direction of causation, the relationship is potentially of high public health importance because of the adverse impact of both states on well-being. It is important that older people in pain are screened for vitamin D status and provided with appropriate interventions.

Relationship between vitamin D and hyperglycemia in older people from a nationally representative population survey.

OBJECTIVES: To investigate the association between vitamin D levels and hyperglycemia in a national community sample of older people. DESIGN: Cross-sectional, nationally representative sample. SETTING: Community. PARTICIPANTS: Two thousand thirty-eight noninstitutitionalized adults aged 65 and older taking part in the Health Survey for England 2005. MEASUREMENTS: Serum 25-hydroxy vitamin D (25(OH) D) levels, glycosylated hemoglobin (HbA1c), and covariates: age, sex, social class, season of examination, use of vitamin supplements, and physical health status. RESULTS: Hyperglycemia was independently associated with low vitamin D levels (odds ratio (OR) = 2.30, 95% confidence interval (CI) = 1.20-4.42 for 25(OH)D <25.0 nmol/L and OR = 2.09, 95% CI = 1.22-3.58 for 25(OH)D 25.0-49.9 nmol/L) but not for 25(OH)D between 50.0 and 74.9 nmol/L (OR = 1.49, 95% CI = 0.85-2.62). CONCLUSION: The higher-than-expected co-occurrence of low vitamin D levels and hyperglycemia (HbA1c ≥ 6.5%) are important public health concerns for older populations living in northern latitudes because both are common, and both have substantial adverse health consequences. Ensuring adequate vitamin D levels may help reverse the increasing trend in the development of diabetes mellitus and related complications in older people.

Urgent action needed to improve vitamin D status among older people in England!

BACKGROUND: the importance of vitamin D for bone health is well known, but emerging evidence also suggests that adequate vitamin D status may also be protective against non-communicable diseases. In the UK, government initiatives highlighting the importance of adequate vitamin D among older people have been in place since 1998. OBJECTIVES: the aim of this analysis is to assess vitamin D status in people aged > or =65, living in private households in England, 2005 and make comparisons with the Health Survey for England (HSE) 2000 and the National Diet and Nutrition Survey (NDNS), 1994. We also examine associations of hypovitaminosis D [serum 25(OH)D <50 nmol/l] with demographic, geographic, lifestyle and health risk factors. DESIGN AND SETTING: a nationally representative sample of older people living in England in 2005. PARTICIPANTS: 2,070 adults aged > or =65, living in private households taking part in the HSE 2005. RESULTS: in the HSE 2005, mean serum 25(OH)D levels were 53 and 49 nmol/l in men and women, respectively, these levels are significantly lower than currently recommended at > or =75 nmol/l. Prevalence of vitamin D deficiency [25(OH)D <25 nmol/l] in people aged > or =65 in 2005 was 13% in women and 8% in men. Nearly two thirds (57%) of women and half of men (49%) had serum 25(OH)D <50 nmol/l. Only 16% of men and 13% of women aged > or =65 years had serum 25(OH)D levels > or =75 nmol/l. There is no improvement in vitamin D status in 2005 compared to 2000 and a significant decline in vitamin D status among men in 2005 in comparison to the 1994/1995 NDNS results. The odds of hypovitaminosis D increased by age group from those aged 75-79 to aged > or =85. Season of taking a blood sample, obesity, dark skin pigmentation, not taking vitamin supplements, cigarette smoking, poor general health and longstanding illness were all significant predictors (P < 0.05) of serum 25(OH)D status in adjusted regression models. CONCLUSIONS: poor vitamin D status of older people continues to be a public health problem in England. Hypovitaminosis D is associated with many risk factors and poor health outcomes. There is now an urgent need for a uniform policy on assessment and dietary supplementation of vitamin D in older people to prevent poor vitamin D status and its negative consequences.

Predictors of 25-hydroxyvitamin D status among adults in two British national surveys.

Several recent reports have found a high prevalence of vitamin D deficiency in the adult British population. The present paper investigates the associations of low income/material deprivation and other predictors of serum 25-hydroxyvitamin D (25(OH)D) status in two surveys: The National Diet and Nutrition Survey (NDNS) of the population aged 19-64 years in mainland Britain and the Low Income Diet and Nutrition Survey (LIDNS) of adults aged > or = 19 years in all regions of the UK who were screened to identify low-income/materially deprived households. A valid serum 25(OH)D sample was obtained in 1297 and 792 participants from the NDNS and LDNS respectively. The NDNS participants who were not receiving benefits (n 1054) had a mean 25(OH)D of 50.1 nmol/l, which was higher than among NDNS participants receiving benefits (n 243) with a mean 25(OH)D of 43.0 nmol/l (P < 0.001) and the LIDNS sample (46.5 nmol/l; P < 0.05). For all three samples, the season of drawing blood, skin colour, dietary intake of vitamin D, and intake of dietary supplements were significant predictors (P < 0.05) of serum 25(OH)D status in mutually adjusted regression models. National prevention and treatments strategies of poor vitamin D status need to be targeted to include the adult population, particularly deprived populations, in addition to the elderly and ethnic minorities.