Shu Chang, Zheng Chenguang, Du Xin, Luo Da
Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China.
Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China.
Front Nutr. 2024 Jun 4;11:1356071. doi: 10.3389/fnut.2024.1356071. eCollection 2024.
The relationship between vitamin D levels, depressive symptoms, and cognitive function has yet to be definitively understood in the elderly, particularly when considering the impact of chronic diseases. This study focuses on how depression mediates the impact of 25-hydroxyvitamin D3 (25(OH)D3) on cognitive performance in older U.S. adults.
We analyzed data from 2,745 elderly individuals extracted from the NHANES 2011-2014 cycles, applying weighted processing to account for the complex multi-stage sampling design characteristic of NHANES data. Utilizing weighted data for covariate and model selection, we conducted mediation analyses on both the overall population and subgroup data. Significant mediation pathways were validated using a stratified weighted bootstrap approach. For significant subgroup pathways, we explored interactive mechanisms through interactive mediation analysis.
Mediation analyses, thoroughly accounting for the impact of chronic conditions, revealed significant pathways in both the weighted overall population and the weighted diabetes subgroup. After 1,000 stratified weighted bootstrap replications, the proportion of mediation effects were 10.6% [0.040, 0.268] and 20.9% [0.075, 0.663], respectively. Interactive mediation analysis for diabetes indicated that the interaction between diabetes and depression was not significant in the direct pathway (estimates = 0.050, = 0.113) but was significant in the mediation pathway, yielding the largest effect size compared to other covariates (estimates = 0.981, < 0.001).
This study highlights the mediating role of depression in the relationship between vitamin D levels and cognitive function in the elderly, particularly emphasizing diabetes as a key moderator. Our findings suggest targeted interventions addressing both vitamin D sufficiency and depression could significantly benefit cognitive health, especially in diabetic individuals.
老年人中维生素D水平、抑郁症状和认知功能之间的关系尚未完全明确，尤其是在考虑慢性病影响的情况下。本研究聚焦于抑郁症如何介导25-羟基维生素D3（25(OH)D3）对美国老年成年人认知表现的影响。
我们分析了从2011 - 2014年美国国家健康与营养检查调查（NHANES）周期中提取的2745名老年人的数据，并应用加权处理来考虑NHANES数据复杂的多阶段抽样设计特征。利用加权数据进行协变量和模型选择，我们对总体人群和亚组数据进行了中介分析。使用分层加权自助法验证了显著的中介途径。对于显著的亚组途径，我们通过交互中介分析探索了交互机制。
在充分考虑慢性病影响的中介分析中，加权总体人群和加权糖尿病亚组均显示出显著途径。经过1000次分层加权自助重复抽样后，中介效应比例分别为10.6%[0.040, 0.268]和20.9%[0.075, 0.663]。糖尿病的交互中介分析表明，糖尿病与抑郁症之间的交互作用在直接途径中不显著（估计值 = 0.050，P = 0.113），但在中介途径中显著，与其他协变量相比产生了最大的效应量（估计值 = 0.981，P < 0.001）。
本研究强调了抑郁症在老年人维生素D水平与认知功能关系中的中介作用，尤其强调糖尿病作为关键调节因素。我们的研究结果表明，针对维生素D充足和抑郁症的靶向干预可能会显著有益于认知健康，特别是在糖尿病患者中。
