The effect of vitamin D and frailty on mortality among non-institutionalized US older adults

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European Journal of Clinical Nutrition advance online publication 13 June 2012; doi: 10.1038/ejcn.2012.67

E Smit1, C J Crespo2, Y Michael3, F A Ramirez-Marrero4, G R Brodowicz2, S Bartlett5 and R E Andersen5

  1. 1Department of Public Health, Oregon State University, Corvallis, OR, USA
  2. 2School of Community Health, Portland State University, Portland, OR, USA
  3. 3Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
  4. 4Department of Exercise Science, University of Puerto Rico, San Juan, Puerto Rico
  5. 5Departments of Kinesiology and Physical Education, and Medicine, McGill University, Montréal, QC, Canada

Correspondence: Dr E Smit, Department of Public Health, Oregon State University, Waldo 316, Corvallis, OR 97331, USA. E-mail:

Received 21 February 2012; Revised 30 April 2012; Accepted 30 April 2012
Advance online publication 13 June 2012



Although both frailty and low vitamin D have been separately associated with an increased risk for adverse health, their joined effects on mortality have not been reported. The current study examined prospectively the effects of frailty and vitamin D status on mortality in US older adults.


Participants aged greater than or equal to60 years in The Third National Health and Nutrition Examination Survey with 12 years of mortality follow-up were included in the analysis (n=4731). Frailty was defined as meeting three or more criteria and pre-frailty as meeting one or two of the five frailty criteria (low body mass index (BMI), slow walking, weakness, exhaustion and low physical activity). Vitamin D status was assessed by serum 25-hydroxyvitamin D (25(OH)D) and categorized into quartiles. Analyses were adjusted for gender, race, age, smoking, education, latitude and other comorbid conditions.


Serum 25(OH)D concentrations were lowest in participants with frailty, intermediate in participants with pre-frailty and highest in participants without frailty. The odds of frailty in the lowest quartile of serum 25(OH)D was 1.94 times the odds in the highest quartile (95%confidence interval (CI): 1.09–3.44). Mortality was positively associated with frailty, with the risk among participants who were frail and had low serum 25(OH)D being significantly higher than those who were not frail and who had high concentrations of serum 25(OH)D (hazards ratio 2.98; 95%CI: 2.01–4.42).


Our results suggest that low serum 25(OH)D is associated with frailty, and there is additive joint effects of serum 25(OH)D and frailty on all-cause mortality in older adults.


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