Bouloukaki Izolde, Christodoulakis Antonios, Tsiligianni Ioanna
Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece.
Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece; Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece.
Clin Nutr ESPEN. 2025 Jun;67:665-672. doi: 10.1016/j.clnesp.2025.04.013. Epub 2025 Apr 24.
BACKGROUND & AIMS: While low vitamin D levels are common in Chronic Obstructive Pulmonary Disease (COPD) and have been associated with various adverse COPD-related outcomes, data on vitamin D status in rural COPD cohorts is limited. Therefore, the present study aimed to assess the prevalence of Vitamin D deficiency among patients with COPD living in rural areas and explore its potential association on the overall health status.
This cross-sectional study included 138 participants >40 years with COPD from the prospective "COlaborative care vs usual CARE in primary care patients with COPD" (COCARE) study. Sociodemographic characteristics, medical history, patient's health-related quality of life (HRQoL) with the COPD Assessment Test (CAT), fatigue with the Fatigue Severity Scale (FSS), phycological parameters with Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7), sleep disorders with the COPD and Asthma Sleep Impact Scale (CASIS), Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were collected. Vitamin D deficiency was defined as levels of 25-hydroxy (OH)-Vitamin D below 20 ng/mL. Multiple logistic regression analysis was conducted to test for associations of Vitamin D deficiency with CAT, FSS, PHQ-9, GAD-7, CASIS, AIS, and ESS, adjusting for age, gender, smoking status, comorbidities, and seasonality.
Most of the participants were male (70 %) with a mean age of 68 ± 9 years and a mean Body Mass Index (BMI) of 30 ± 6 kg/m. Moreover, 33 % of the participants had Vitamin D deficiency. Vitamin D deficiency increased the odds for worse HRQoL (CAT≥10 OR: 2.3, CI: 0.9-6.4, p = 0.008), greater fatigue severity (FSS, OR: 1.2, CI: 0.4-3.1, p = 0.756), more depressive (PHQ-9≥5, OR: 2.9, CI: 1.1-7.4, p = 0.024), anxiety (GAD-7, OR: 0.8, CI: 0.3-2.1, p = 0.592) and insomnia symptoms (AIS score OR: 1.1, CI: 0.7-5, p = 0.29), excessive daytime sleepiness (ESS, OR: 1.1, CI: 0.7-5, p = 0.29), and lower sleep quality (CASIS OR: 2.5, CI: 0.9-6.5, p = 0.006).
In conclusion, our findings indicate that Vitamin D deficiency is positively associated with numerous negative health outcomes of patients with COPD, including worse HRQoL, fatigue, depression, anxiety and sleep disorders. However, further research is needed to determine the role of Vitamin D in the health status of these patients.
虽然慢性阻塞性肺疾病（COPD）患者中维生素D水平较低的情况很常见，且与各种COPD相关的不良后果有关，但农村COPD队列中维生素D状况的数据有限。因此，本研究旨在评估农村地区COPD患者中维生素D缺乏的患病率，并探讨其与整体健康状况的潜在关联。
这项横断面研究纳入了前瞻性“COPD初级保健患者的协作护理与常规护理对比”（COCARE）研究中138名年龄大于40岁的COPD参与者。收集了社会人口学特征、病史、通过COPD评估测试（CAT）得出的患者健康相关生活质量（HRQoL）、通过疲劳严重程度量表（FSS）得出的疲劳程度、通过患者健康问卷-9（PHQ-9）和广泛性焦虑障碍-7（GAD-7）得出的心理参数、通过COPD与哮喘睡眠影响量表（CASIS）、雅典失眠量表（AIS）和爱泼华嗜睡量表（ESS）得出的睡眠障碍情况。维生素D缺乏定义为25-羟基（OH）维生素D水平低于20 ng/mL。进行了多因素逻辑回归分析，以检验维生素D缺乏与CAT、FSS、PHQ-9、GAD-7、CASIS、AIS和ESS之间的关联，并对年龄、性别、吸烟状况、合并症和季节性进行了校正。
大多数参与者为男性（70%），平均年龄为68±9岁，平均体重指数（BMI）为30±6 kg/m。此外，33%的参与者存在维生素D缺乏。维生素D缺乏增加了以下不良情况的几率：较差的HRQoL（CAT≥10，比值比：2.3，置信区间：0.9-6.4，p = 0.008）、更高的疲劳严重程度（FSS，比值比：1.2，置信区间：0.4-3.1，p = 0.756）、更多的抑郁症状（PHQ-9≥5，比值比：2.9，置信区间：1.1-7.4，p = 0.024）、焦虑症状（GAD-7，比值比：0.8，置信区间：0.3-2.1，p = 0.592）和失眠症状（AIS评分，比值比：1.1，置信区间：0.7-5，p = 0.29）、白天过度嗜睡（ESS，比值比：1.1，置信区间：0.7-5，p = 0.29）以及更低的睡眠质量（CASIS，比值比：2.5，置信区间：0.9-6.5，p = 0.006）。
总之，我们的研究结果表明，维生素D缺乏与COPD患者的众多负面健康结果呈正相关，包括较差的HRQoL、疲劳、抑郁、焦虑和睡眠障碍。然而，需要进一步研究来确定维生素D在这些患者健康状况中的作用。
