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- Samefors, Maria, 1980-
(författare)
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Aspects of Vitamin D Deficiency in Elderly People in Nursing Homes and in Patients with Type 2 Diabetes : with Emphasis on Mortality, Cardiovascular Morbidity and Mental Health
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundInstitutionalised elderly people living in northern latitudes may be at elevated risk for vitamin D deficiency. They are recommended to take oral vitamin D supplements, but the main source of vitamin D is sunlight. Previous studies have shown an association between low levels of vitamin D and several diseases, but important knowledge about vitamin D in elderly people in nursing homes and in patients with type 2 diabetes is lacking. The aims of this thesis were to study aspects of vitamin D deficiency in these two populations and to explore whether low vitamin D levels were associated with mortality, cardiovascular morbidity and mental health. Also, we aimed to examine whether an intervention with encouragement to spend time outdoors during summer could increase vitamin D levels in the elderly in nursing homes.MethodsThe present thesis is based on four papers. Papers I and IV are confined to nursing home residents >65 years. Paper I is based on data from SHADES (The Study of Health and Drugs in the Elderly). Paper IV is based on the study Sunlight and Vitamin D in Older People in Nursing Homes. Papers II and III are based on data from CARDIPP (Cardiovascular Risk Factors in Patients with Diabetes—a Prospective Study in Primary Care), with patients with type 2 diabetes aged 55-66 years. Papers I-III were prospective observational cohort studies and Paper IV was a cluster randomised intervention trial.In Paper I, serum 25-hydroxyvitamin D3 (25(OH)D3) was analysed on three occasions. The vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to baseline 25(OH)D3 quartiles (Q) were calculated.In Paper II, serum 25(OH)D3 was analysed at baseline. HRs for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D3 were calculated.In Paper III, serum 25(OH)D3 was analysed at baseline. The SF-36 questionnaires measuring vitality and mental health were administered at baseline and after four years.In Paper IV, the intervention group was encouraged to go outside for 20-30 minutes every day for two months during the summer of 2018. Before and after the summer, serum 25(OH)D was analysed and SF-36 questionnaires measuring vitality and mental health were administered.ResultsIn Paper I, 80% of the participants had 25(OH)D3 < 50 nmol/l. Vitamin D deficiency was associated with an increased mortality risk. Compared with Q4 (25(OH)D3 >48 nmol/l), the HR (with a 95% confidence interval (CI)) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D3 <29 nmol/l) (p<0.05), 2.03 (1.32-3.14) in Q2 (25(OH)D3 30-37 nmol/l) (p<0.05) and 1.6 (1.03-2.48) in Q3 (25(OH)D3 38-47 nmol/l) (p<0.05).In Paper II, serum 25(OH)D3 was inversely associated with the risk of cardiovascular morbidity and mortality. The HR per nmol/l was 0.98 (95% CI: 0.96-0.99) (p=0.001), when adjusted for age, sex and season.In Paper III, serum 25(OH)D3 was inversely associated with poor mental health at baseline. The odds ratio (OR) for 10 nmol/l increase in 25(OH)D3 was 0.90 (95% CI: 0.83-0.96) (p=0.003), but not at follow-up (p>0.05). Serum 25(OH)D3 was not associated with vitality at baseline (p>0.05), nor at follow-up after adjustments.In Paper IV, the 25(OH)D levels increased significantly in the intervention group during the summer: from a median (interquartile range (IQR)) of serum 25(OH)D of 42.5 (23.0) nmol/l to 53.5 (33.0) nmol/l (p=0.011). The 25(OH)D levels increased in the control group as well, but the increase was not significant. The intervention group reported better mental health after the summer compared to before the summer (p=0.015), unlike the control group.ConclusionsLow vitamin D levels were associated with increased mortality in elderly people in nursing homes, and with cardiovascular morbidity/ mortality and poor mental health in patients with type 2 diabetes. From our studies, we cannot draw conclusions about causality. The results indicate that the vitamin D levels give prognostic information. Active encouragement to spend time outdoors during summer improved the vitamin D levels and mental health in elderly people in nursing homes, and such activity could be considered as a complement to oral vitamin D supplementation in the summer.
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| 2. |
- Samefors, Maria, 1980-, et al.
(författare)
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Association between serum 25(OH)D-3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study
- 2017
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Ingår i: Diabetic Medicine. - : WILEY. - 0742-3071 .- 1464-5491. ; 34:3, s. 372-379
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Tidskriftsartikel (refereegranskat)abstract
- Aim We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group. Methods A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes -A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D-3 [25(OH)D-3] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D-3. Results We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D-3 was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D-3 amp;gt; 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D-3 amp;lt; 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D-3 35.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D-3 47.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027). Conclusions Low 25(OH)D-3 is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.
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| 3. |
- Samefors, Maria, et al.
(författare)
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Is there an association between serum 25(OH)D-3 and mental well-being in patients with type 2 diabetes? Results from a cohort study in primary care
- 2020
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Ingår i: HORMONES-INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM. - : SPRINGER INTERNATIONAL PUBLISHING AG. - 1109-3099. ; 19, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- Purpose There are limited and inconsistent results on the correlation between vitamin D and mental health in patients with type 2 diabetes (T2D). Thus, our aim was to explore the association between vitamin D and mental well-being in a community-based sample of participants with T2D. Methods We analyzed serum 25-hydroxyvitamin D-3 (25(OH)D-3) in 698 patients with T2D at the baseline examination. The cohort was reinvestigated after 4 years. Data from SF-36 questionnaires measuring vitality and mental health at baseline and after 4 years were used for analyses. Results Serum 25(OH)D-3 was inversely associated with poor mental health at baseline (odds ratio (OR) for 10 nmol/l increase in 25(OH)D-3, 0.90 (95% confidence interval (CI) 0.83-0.96, p = 0.003)) but not at follow-up (p > 0.05). Serum 25(OH)D-3 was not associated with vitality at baseline (p > 0.05). At follow-up, there was an inverse association between 25(OH)D-3 and low vitality (OR for 10 nmol/l increase in 25(OH)D-3, 0.89 (95% CI 0.82-0.97, p = 0.009)) but not after adjustment. Conclusion We found an inverse association between 25(OH)D-3 and mental health in patients with T2D at baseline. We found no association between 25(OH)D-3 and vitality after adjustment. Future studies are needed to determine the association between vitamin D and mental well-being in patients with T2D.
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| 4. |
- Samefors, Maria, et al.
(författare)
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Sunlight Exposure and Vitamin D Levels in Older People-An Intervention Study in Swedish Nursing Homes
- 2020
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Ingår i: The Journal of Nutrition, Health & Aging. - : SPRINGER FRANCE. - 1279-7707 .- 1760-4788. ; 24, s. 1047-1052
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Older people are recommended to take oral vitamin D supplements, but the main source of vitamin D is sunlight. Our aim was to explore whether active encouragement to spend time outdoors could increase the levels of serum 25-hydroxyvitamin D (25(OH)D) and increase the mental well-being of nursing home residents. Design A cluster randomized intervention trial. Setting Nursing homes in southern Sweden. Participants In total 40 people >65 years. Intervention The intervention group was encouraged to go outside for 20-30 minutes between 11 a.m. and 3 p.m. every day for two months during the summer of 2018. Measurements We analyzed serum 25(OH)D before and after the summer. Data from SF-36 questionnaires measuring vitality and mental health were used for the analyses. Results In the intervention group, the baseline median (interquartile range (IQR)) of serum 25(OH)D was 42.5 (23.0) nmol/l and in the control group it was 52.0 (36.0) nmol/l. In the intervention group, the 25(OH)D levels increased significantly during the summer (p=0.011). In the control group, there was no significant change. The intervention group reported better self-perceived mental health after the summer compared to before the summer (p=0.015). In the control group, there was no difference in mental health. Conclusion Active encouragement to spend time outdoors during summertime improved the levels of serum 25(OH)D and self-perceived mental health significantly in older people in nursing homes and could complement or replace oral vitamin D supplementation in the summer.
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| 5. |
- Samefors, Maria, et al.
(författare)
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Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality
- 2014
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Ingår i: European Journal of Endocrinology. - : Bioscientifica. - 0804-4643 .- 1479-683X. ; 170:5, s. 667-675
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality.DESIGN:The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden.METHODS:We analysed the levels of 25-hydroxyvitamin D₃ (25(OH)D₃) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D₃ quartiles were calculated.RESULTS:We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D₃ >48 nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D₃ <29 nmol/l) (P<0.05); 2.03 (1.32-3.14) in Q2 (25(OH)D₃ 30-37 nmol/l) (P<0.05) and 1.6 (1.03-2.48) in Q3 (25(OH)D₃ 38-47 nmol/l) (P<0.05). The mean 25(OH)D₃ concentration was 40.2 nmol/l (S.D. 16.0) and 80% had 25(OH)D₃ below 50 nmol/l. The vitamin D levels decreased from baseline to the second and third measurements.CONCLUSIONS:Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.
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