Girgis Christian M
aGarvan Institute of Medical Research bFaculty of Medicine, University of Sydney, Sydney, NSW, Australia.
Curr Opin Clin Nutr Metab Care. 2014 Nov;17(6):546-50. doi: 10.1097/MCO.0000000000000104.
Circumstantial evidence suggests that vitamin D deficiency may contribute to age-related changes in skeletal muscle. This review discusses recent clinical trials examining effects of vitamin D on muscle function in the elderly, and poses the important question: can vitamin D reverse muscle ageing?
Observational studies report an association between vitamin D and muscle atrophy/weakness in elderly subjects. Interventional studies suggest that frail, elderly subjects may benefit from vitamin D supplementation by displaying reduced falls, improved muscle function and increased muscle fibre size. However, meta-analyses do not report convincing effects of vitamin D in the elderly. This may be because of multiple factors including lack of standardized endpoints for muscle function, variable study design and different doses of vitamin D supplementation amongst these studies. The evidence base is therefore inconsistent.
Vitamin D deficiency may exacerbate ageing of skeletal muscle. However, current evidence that vitamin D supplementation reverses age-related muscle dysfunction is equivocal and does not justify stringent vitamin D targets in the elderly. Until these issues are clarified, the safest option is to aim for conservative vitamin D targets that are sufficient for normal calcium homeostasis.
有间接证据表明维生素D缺乏可能导致骨骼肌的年龄相关性变化。本综述讨论了近期关于维生素D对老年人肌肉功能影响的临床试验,并提出了一个重要问题:维生素D能逆转肌肉衰老吗?
观察性研究报告了老年人维生素D与肌肉萎缩/无力之间的关联。干预性研究表明,体弱的老年人补充维生素D可能有益,表现为跌倒减少、肌肉功能改善和肌纤维尺寸增加。然而,荟萃分析并未报告维生素D对老年人有令人信服的效果。这可能是由于多种因素,包括缺乏肌肉功能的标准化终点、研究设计的差异以及这些研究中维生素D补充剂的不同剂量。因此,证据基础并不一致。
维生素D缺乏可能会加剧骨骼肌衰老。然而,目前关于补充维生素D可逆转年龄相关性肌肉功能障碍的证据并不明确,也没有理由为老年人设定严格的维生素D目标。在这些问题得到澄清之前,最安全的选择是设定保守的维生素D目标,以维持正常的钙稳态。