Field Notes

Routine Tasks Pose Problems for Older Individuals
With Vitamin D Deficiency

Vitamin D-deficient older individuals are more likely to struggle with everyday tasks such as dressing or climbing stairs, according to a recent study accepted for publication in the Journal of Clinical Endocrinology & Metabolism.

Scientists estimate as many as 90% of older individuals are vitamin D deficient. A vitamin D deficiency can lead to a decline in bone density, muscle weakness, osteoporosis, or broken bones.

“Seniors who have low levels of vitamin D are more likely to have mobility limitations and to see their physical functioning decline over time,” says the study’s lead author, Evelien Sohl, MSc, of VU University Medical Center in Amsterdam, the Netherlands. “Older individuals with these limitations are more likely to be admitted to nursing homes and face a higher risk of mortality.”

Using data from an ongoing Dutch cohort study (the Longitudinal Aging Study Amsterdam), the researchers examined two groups—762 people between the ages of 65 and 88, and 597 people between the ages of 55 and 65—over the course of six years. Using blood test results, the subjects were split into groups with high, moderate, and low vitamin D levels. To assess mobility limitations, participants were asked about their ability to perform routine tasks, including sitting down and standing up from a chair or walking outside for five minutes without resting.

Among the older group of participants, people with the lowest vitamin D levels were 1.7 times more likely to have at least one functional limitation compared with those with the highest vitamin D levels. In the younger cohort, individuals with low vitamin D levels were twice as likely to have at least one physical limitation.

While the majority of the people in the older cohort’s top two vitamin D groups didn’t report any physical limitations, 70% of the people with the lowest vitamin D levels had at least one limitation.

In addition, the study found vitamin D-deficient individuals were more likely to develop additional limitations over time. The older cohort reported more mobility issues after three years, while the younger cohort developed additional limitations over the course of six years.

“The findings indicate low vitamin D levels in older individuals may contribute to the declining ability to perform daily activities and live independently,” Sohl says. “Vitamin D supplementation could provide a way to prevent physical decline, but the idea needs to be explored further with additional studies.”

Source: Endocrine Society


People With Prediabetes Who Drop Weight
May Ward Off Type 2 Diabetes

People with prediabetes who lose roughly 10% of their body weight within six months of diagnosis dramatically reduce their risk of developing type 2 diabetes over the next three years, according to research led by Johns Hopkins scientists. The report was published online in the Journal of General Internal Medicine.

The findings, investigators say, offer patients and physicians a guide to how short-term behavior change may affect long-term health.

“We have known for some time that the greater the weight loss, the lower your risk of diabetes,” says study leader Nisa Maruthur, MD, MHS, an assistant professor in the division of general internal medicine at the Johns Hopkins University School of Medicine. “Now we understand that we can see much of the benefit of losing that weight in those first six months when people are adjusting to a new way of eating and exercising. Substantial weight loss in the short term clearly should go a long way toward preventing diabetes.”

Preventing prediabetes from becoming full-blown diabetes is critical, Maruthur says. Uncontrolled diabetes can lead to eye, kidney, and nerve damage as well as cardiovascular disease. The new research suggests that if people with prediabetes don’t lose enough weight in those first months, physicians may want to consider more aggressive treatment, such as adding a medication to push blood sugar levels lower.

Maruthur and her colleagues based their conclusions on an analysis of data from the Diabetes Prevention Program, the largest diabetes prevention study in the United States. Overweight, hyperglycemic people were recruited between 1996 and 1999 and followed for an average of 3.2 years. More than 3,000 participants at 27 academic medical centers were assigned at random either to receive an intense lifestyle intervention, doses of the diabetes drug metformin designed to reduce blood glucose levels, or a placebo. Maruthur and her colleagues searched the study information for links among short-term weight loss, the reduction of blood glucose levels, and the impact on the longer-term risk of developing diabetes.

Although not all people with prediabetes develop full-blown type 2 disease, without intervention the risk of getting it within 10 years is substantially increased and damage to health already may have begun. The good news, Maruthur says, is that studies show the progression from prediabetes to type 2 diabetes isn’t inevitable, and lifestyle changes can bring blood sugar levels back to normal.

Participants in the lifestyle arm of the Diabetes Prevention Program were advised about better eating habits, directed to exercise 150 minutes per week, and given one-on-one counseling for the first six months and group counseling thereafter. Researchers found that those in the lifestyle intervention arm who lost 10% or more of their body weight had an 85% reduction in their risk of developing diabetes within three years. Even more moderate weight loss showed positive effects. Those who lost 5% to 7% of their body weight reduced their risk of developing diabetes by 54% three years later.

Those who were given metformin didn’t lose significant amounts of weight on average. But those whose blood sugar levels were significantly lowered in six months of taking the medication saw their future risk of developing diabetes fall as well.

The lowest risk, Maruthur says, occurred in patients who lost weight and also lowered the amount of glucose in their blood, as measured by a blood test taken after fasting.

“I’m usually thrilled if a patient loses 3% to 5% of his or her body weight after six months, but based on this new knowledge, if patients aren’t losing more weight and if their glucose remains elevated, it might be time to escalate treatment by prescribing metformin,” she says.

Maruthur says few physicians use metformin in patients with prediabetes, but given what her study shows, it may make sense for physicians to consider prescribing the drug to patients who are unable or unwilling to lose substantial weight in the short term.

She says physicians don’t effectively provide behavior modification programs, in part because insurance rarely covers them. The new research suggests just how valuable and potentially cost-effective such interventions could be, she says.

Source: Johns Hopkins Medicine