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Vitamin D insufficiency and cognitive impairment in Asians: a multi-ethnic population-based study and meta-analysis.

Abstract

BACKGROUND

The relationship between vitamin D insufficiency and cognitive impairment remains equivocal in Asians. We examined the association between circulating 25-hydroxyvitamin D (25OHD) concentration and cognitive performance in a large multi-ethnic Singaporean population-based study. We also conducted a meta-analysis of 25OHD concentrations amongst cognitively impaired older adults in Asia.

METHODS

Our population-based cross-sectional study included 2273 persons ≥60 years of age from the Singapore Epidemiology of Eye Diseases (SEED) study (mean ± SD age 70.4 ± 6.2 years; 44.7% female), who were categorized according to 25OHD concentration (i.e. ≤10, 10.1-20 and >20 ng mL(-1) ). The 25OHD concentration was measured and adjusted to reflect a deseasonalized value. Cognition was assessed using the total and domain scores of the Abbreviated Mental Test (AMT). Global cognitive impairment was defined as AMT score of ≤6 if 0-6 years of education and AMT score of ≤8 if >7 years of education. Fully adjusted multivariate models were used. We included seven studies in a meta-analysis of 25OHD and cognition in Asia (6068 participants; 1179 cognitively impaired cases).

RESULTS

Participants with 25OHD levels >20 ng mL(-1) (n = 1302) had higher AMT total scores (mean ± SD 8.5 ± 1.9) and were less likely to have cognitive impairment (14.1%) than participants with lower 25OHD levels (overall P < 0.001, P-trend < 0.001). Deseasonalized 25OHD concentration was associated with AMT score (β = 0.10 per 10 ng mL(-1) , P = 0.035). Vitamin D insufficiency (25OHD ≤20 ng mL(-1) ) was associated with global cognitive impairment (OR 1.56, P = 0.028). Specifically, 25OHD concentration correlated with semantic memory (r = 0.08, P = 0.009) and orientation in time (r = 0.09, P = 0.003). In the meta-analysis, the pooled mean 25OHD difference was -6.83 ng mL(-1) (95% confidence interval -11.36; -2.30), indicating lower 25OHD concentrations amongst cognitively impaired compared to cognitively healthy participants in Asia.

CONCLUSION

Vitamin D insufficiency is associated with a greater likelihood of and more severe cognitive impairment in Asian populations.

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  • Authors+Show Affiliations

    ,

    Division of Geriatric Medicine, Department of Neuroscience, Angers University Hospital, University Memory Clinic of Angers, UNAM, University of Angers, Angers, France. Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada.

    ,

    Singapore Eye Research Institute, Singapore. Singapore National Eye Centre, Singapore. Neuroscience and Behavioural Disorders, Duke-NUS, Singapore. Division of Ophthalmology, Department of Neuroscience, Angers University Hospital, Angers, France.

    ,

    Departments of Medicine and Ophthalmology, Duke University Medical School, Durham, NC, USA. Duke Aging Center, Duke University, Durham, NC, USA. Durham VA Medical Center, Geriatrics Research Education and Clinical Center, Durham, NC, USA.

    ,

    Singapore Eye Research Institute, Singapore. Singapore National Eye Centre, Singapore. Ophthalmology and Visual Sciences Academic Clinical Program, Medical School, Duke-NUS, Singapore. Department of Ophthalmology, National University of Singapore, Singapore.

    ,

    Singapore Eye Research Institute, Singapore. Singapore National Eye Centre, Singapore. Ophthalmology and Visual Sciences Academic Clinical Program, Medical School, Duke-NUS, Singapore. Department of Ophthalmology, National University of Singapore, Singapore.

    ,

    Singapore Eye Research Institute, Singapore. Memory Aging & Cognition Centre, National University Health System, Singapore.

    ,

    Singapore Eye Research Institute, Singapore. Singapore National Eye Centre, Singapore. Ophthalmology and Visual Sciences Academic Clinical Program, Medical School, Duke-NUS, Singapore. Department of Ophthalmology, National University of Singapore, Singapore.

    Singapore Eye Research Institute, Singapore. Ophthalmology and Visual Sciences Academic Clinical Program, Medical School, Duke-NUS, Singapore. Department of Ophthalmology, National University of Singapore, Singapore.

    Source

    Journal of internal medicine 280:3 2016 Sep pg 300-11

    MeSH

    Aged
    Asian Continental Ancestry Group
    Cognition Disorders
    Cross-Sectional Studies
    Female
    Humans
    Male
    Middle Aged
    Risk Factors
    Singapore
    Vitamin D
    Vitamin D Deficiency

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    27037788

    Citation

    Annweiler, C, et al. "Vitamin D Insufficiency and Cognitive Impairment in Asians: a Multi-ethnic Population-based Study and Meta-analysis." Journal of Internal Medicine, vol. 280, no. 3, 2016, pp. 300-11.
    Annweiler C, Milea D, Whitson HE, et al. Vitamin D insufficiency and cognitive impairment in Asians: a multi-ethnic population-based study and meta-analysis. J Intern Med. 2016;280(3):300-11.
    Annweiler, C., Milea, D., Whitson, H. E., Cheng, C. Y., Wong, T. Y., Ikram, M. K., ... Sabanayagam, C. (2016). Vitamin D insufficiency and cognitive impairment in Asians: a multi-ethnic population-based study and meta-analysis. Journal of Internal Medicine, 280(3), pp. 300-11. doi:10.1111/joim.12491.
    Annweiler C, et al. Vitamin D Insufficiency and Cognitive Impairment in Asians: a Multi-ethnic Population-based Study and Meta-analysis. J Intern Med. 2016;280(3):300-11. PubMed PMID: 27037788.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vitamin D insufficiency and cognitive impairment in Asians: a multi-ethnic population-based study and meta-analysis. AU - Annweiler,C, AU - Milea,D, AU - Whitson,H E, AU - Cheng,C-Y, AU - Wong,T-Y, AU - Ikram,M K, AU - Lamoureux,E L, AU - Sabanayagam,C, Y1 - 2016/04/01/ PY - 2016/4/3/entrez PY - 2016/4/3/pubmed PY - 2017/6/1/medline KW - Asia KW - cognition KW - older adults KW - vitamin D SP - 300 EP - 11 JF - Journal of internal medicine JO - J. Intern. Med. VL - 280 IS - 3 N2 - BACKGROUND: The relationship between vitamin D insufficiency and cognitive impairment remains equivocal in Asians. We examined the association between circulating 25-hydroxyvitamin D (25OHD) concentration and cognitive performance in a large multi-ethnic Singaporean population-based study. We also conducted a meta-analysis of 25OHD concentrations amongst cognitively impaired older adults in Asia. METHODS: Our population-based cross-sectional study included 2273 persons ≥60 years of age from the Singapore Epidemiology of Eye Diseases (SEED) study (mean ± SD age 70.4 ± 6.2 years; 44.7% female), who were categorized according to 25OHD concentration (i.e. ≤10, 10.1-20 and >20 ng mL(-1) ). The 25OHD concentration was measured and adjusted to reflect a deseasonalized value. Cognition was assessed using the total and domain scores of the Abbreviated Mental Test (AMT). Global cognitive impairment was defined as AMT score of ≤6 if 0-6 years of education and AMT score of ≤8 if >7 years of education. Fully adjusted multivariate models were used. We included seven studies in a meta-analysis of 25OHD and cognition in Asia (6068 participants; 1179 cognitively impaired cases). RESULTS: Participants with 25OHD levels >20 ng mL(-1) (n = 1302) had higher AMT total scores (mean ± SD 8.5 ± 1.9) and were less likely to have cognitive impairment (14.1%) than participants with lower 25OHD levels (overall P < 0.001, P-trend < 0.001). Deseasonalized 25OHD concentration was associated with AMT score (β = 0.10 per 10 ng mL(-1) , P = 0.035). Vitamin D insufficiency (25OHD ≤20 ng mL(-1) ) was associated with global cognitive impairment (OR 1.56, P = 0.028). Specifically, 25OHD concentration correlated with semantic memory (r = 0.08, P = 0.009) and orientation in time (r = 0.09, P = 0.003). In the meta-analysis, the pooled mean 25OHD difference was -6.83 ng mL(-1) (95% confidence interval -11.36; -2.30), indicating lower 25OHD concentrations amongst cognitively impaired compared to cognitively healthy participants in Asia. CONCLUSION: Vitamin D insufficiency is associated with a greater likelihood of and more severe cognitive impairment in Asian populations. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/27037788/Vitamin_D_insufficiency_and_cognitive_impairment_in_Asians:_a_multi_ethnic_population_based_study_and_meta_analysis_ L2 - https://doi.org/10.1111/joim.12491 DB - PRIME DP - Unbound Medicine ER -