Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.
Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland.
J Am Geriatr Soc. 2019 Jun;67(6):1211-1217. doi: 10.1111/jgs.15808. Epub 2019 Feb 1.
To test the effect of monthly high-dose vitamin D supplementation on mental health in pre-frail older adults.
Ancillary study of a 1-year double-blind randomized clinical trial conducted in Zurich, Switzerland.
A total of 200 community-dwelling adults 70 years and older with a prior fall event in the last year. Participants were randomized to receive 24 000 IU vitamin D (considered standard of care), 60 000 IU vitamin D , or 24 000 IU vitamin D plus 300 μg calcifediol per month.
The primary end point was the Mental Component Summary (MCS) of the SF-36. Secondary end points were the SF-36 Mental Health (MH) subscale and the Geriatric Depression Scale (GDS-15).
Participants' mean age was 78 years (67% women), and 58% were vitamin D deficient (<20 ng/mL). Over time, primary and secondary end points did not differ significantly among the three treatment groups or in subgroups by vitamin D status at baseline. Given the lack of a true placebo group, we explored in a predefined observational analysis the change in mental health scales by achieved 25(OH)D levels at 12 months. After adjusting for confounders, participants achieving the highest 25(OH)D quartile (Q) at 12 months (44.7-98.9 ng/mL) had the greatest improvements in MCS (Q4 = 0.79 vs Q1 = -2.9; p = .03) and MH scales (Q4 = 2.54 vs Q1 = -3.07; p = .03); these associations were strongest among participants who were vitamin D deficient at baseline. No association was found for GDS (p = .89).
For mental health, our study suggests no benefit of higher monthly doses of vitamin D compared with the standard monthly dose of 24 000 IU. However, irrespective of vitamin D treatment dose, achieving higher 25(OH)D levels at 12-month follow-up was associated with a small, clinically uncertain but statistically significant improvement in mental health scores.
检验每月大剂量维生素 D 补充对衰弱前期老年人心理健康的影响。
在瑞士苏黎世进行的为期 1 年、双盲随机临床试验的辅助研究。
共纳入 200 名居住在社区、年龄在 70 岁及以上且在过去 1 年内有过跌倒事件的成年人，他们被随机分配接受 24 000 IU 维生素 D（视为标准护理）、60 000 IU 维生素 D 或每月 24 000 IU 维生素 D 加 300 μg 骨化二醇。
主要终点是 SF-36 的心理成分综合得分（MCS）。次要终点是 SF-36 心理健康（MH）子量表和老年抑郁量表（GDS-15）。
参与者的平均年龄为 78 岁（67%为女性），58%的人维生素 D 缺乏（<20ng/mL）。随着时间的推移，三组治疗方案或根据基线时维生素 D 状态的亚组之间，主要和次要终点均无显著差异。由于缺乏真正的安慰剂组，我们在预先确定的观察性分析中探讨了在 12 个月时达到的 25（OH）D 水平对心理健康量表的变化。调整混杂因素后，在 12 个月时达到最高 25（OH）D 四分位（Q）的参与者（44.7-98.9ng/mL）MCS（Q4=0.79 与 Q1=-2.9；p=0.03）和 MH 量表（Q4=2.54 与 Q1=-3.07；p=0.03）的改善最大；这些关联在基线时维生素 D 缺乏的参与者中最强。与 GDS 无关联（p=0.89）。
就心理健康而言，与每月 24 000 IU 的标准剂量相比，我们的研究表明较高剂量的维生素 D 每月补充并无益处。然而，无论维生素 D 治疗剂量如何，在 12 个月随访时达到较高的 25（OH）D 水平与心理健康评分的微小、临床不确定但统计学上显著的改善相关。
