DOI QR코드

DOI QR Code

Serum 25-hydroxyvitamin D and cognitive function in Korean older adults living in rural area

농촌 지역에 거주하는 한국 노인의 혈청 비타민 D 농도와 인지기능과의 상관성

  • Shin, Ye Som (Department of Clinical Nutrition, Graduate School of Public Health, Dongduk Women's University) ;
  • Choi, Bo Youl (Department of Preventive Medicine, College of Medicine, Hanyang University) ;
  • Kim, Mi Kyung (Department of Preventive Medicine, College of Medicine, Hanyang University) ;
  • Yang, Yoon Jung (Department of Food and Nutrition, School of Natural Science, Dongduk Women's University)
  • 신예솜 (동덕여자대학교 임상영양학과) ;
  • 최보율 (한양대학교 예방의학교실) ;
  • 김미경 (한양대학교 예방의학교실) ;
  • 양윤정 (동덕여자대학교 식품영양학과)
  • Received : 2019.04.09
  • Accepted : 2019.10.15
  • Published : 2019.10.31

Abstract

Purpose: This study examined the association between the serum 25-hydroxyvitamin D concentration and the cognitive functions in Korean elderly. Methods: The subjects were 393 adults aged 60 years or older who participated in the Yangpyeong cohort between July 2009 and August 2010. The subjects were classified into deficiency, insufficiency, or adequacy groups according to the serum 25-hydroxyvitamin D concentration diagnostic criteria suggested by the US Institute of Medicine (IOM). The cognitive function was assessed based on the Korean version of the Mini-Mental State Examination (MMSE-KC). The dietary intake was assessed using the quantitative food frequency questionnaire with 106 food items. Results: The proportions of deficiency, insufficiency, or adequacy in serum 25-hydroxyvitamin D were 6.6%, 44.5%, and 48.9%, respectively. The serum 25-hydroxyvitamin D concentration was significantly higher in men than in women and in outdoor workers than in other occupations. The adequacy group had higher MMSE-KC scores than the other two groups, but not to a significant degree. The proportion of cognitive impairment tended to decrease with increasing serum vitamin D concentration to deficiency, insufficiency, and adequacy (p for trend = 0.029). The deficiency group had a 2.28 times higher risk of cognitive impairment than the adequacy group, but the difference was not statistically significant (OR, 2.28; 95% CI, 0.18 ~ 1.07, p for trend = 0.119). Conclusion: The serum vitamin D concentration tended to be associated with the cognitive function in elderly Koreans living in rural areas. To confirm the associations, further longitudinal studies with large samples were required.

본 연구는 한국 농촌 지역에 거주하는 60세 이상 노인 393명을 대상으로 혈청 비타민 D 상태와 영양소 섭취량을 파악하고, 비타민 D와 인지기능 사이의 상관성을 밝혔다. 미국 IOM의 비타민 D 진단 기준에 따라 대상자는 결핍군 26명 (6.6%), 부족군 175명 (44.5%), 충분군 192명 (48.9%)으로 분류되었다. 인구사회학적 특징을 세 군에 따라 분석한 결과, 충분군에서 남성과 음주자 비율, 실외직 비율, 키, 체중이 가장 높았다. 모든 영양소 섭취량에서는 유의적인 차이가 없었다. 인지기능을 평가하는 MMSE-KC의 총 점수는 충분군일수록 높았으며, 부분별로 지남력, 기억 등록, 집중력, 구성능력에서 충분군의 점수가 가장 높았으나 유의적인 차이는 없었다. 인지기능 저하 비율은 결핍군 53.8%, 부족군 38.3%, 충분군 31.9%로 혈청 비타민 D 농도가 높을수록 낮아졌으며, 유의미한 상관성이 있었다. 비타민 D 결핍군일수록 인지기능 저하의 위험도가 높아졌으나, 통계적으로 유의적인 차이는 없었다. 이 결과를 토대로 혈청 비타민 D 농도가 인지기능 저하와 관련이 있음을 확인할 수 있었다. 노인들은 노화로 인해 피부의 합성능력이 저하되어 비타민 D가 결핍되기 쉬우므로 인지기능 저하 및 치매의 예방을 위해 육류, 생선, 버섯 및 유제품등의 비타민 D 급원 식품이나 보충제 섭취가 필요하다고 생각된다. 상기 연구를 바탕으로 후속 연구는 비타민 D와 인지기능 사이의 인과관계를 밝힐 수 있는 코호트나 임상 연구가 요구된다.

Keywords

References

  1. Statistics Korea. Statistics on the elderly 2016 [Internet]. Daejeon: Statistics Korea; 2016 [cited 2016 Sep 23]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/6/1/index.board?bmode=read&aSeq=356426.
  2. Ministry of Health and Welfare. Nationwide study on the prevalence of dementia in Korea elders [Internet]. Seoul: Ministry for Health and Welfare; 2012 [cited 2013 May 2]. Available from: http://www.mohw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=286138&page=1.
  3. Jung K, Lee YA, Kim SY, Chang N. Associations of cognitive function and dietary factors in elderly patients with Alzheimer's disease. Korean J Nutr 2008; 41(8): 718-732.
  4. Choi KG. Neuropathology of MCI: view from relationships with aging and Alzheimer's disease. Dement Neurocogn Disord 2003; 2(2): 101-107.
  5. Bae JB, Kim YJ, Han JW, Kim TH, Park JH, Lee SB, et al. Incidence of and risk factors for Alzheimer's disease and mild cognitive impairment in Korean elderly. Dement Geriatr Cogn Disord 2015; 39(1-2): 105-115. https://doi.org/10.1159/000366555
  6. Burgener SC, Buettner L, Coen Buckwalter K, Beattie E, Bossen AL, Fick DM, et al. Evidence supporting nutritional interventions for persons in early stage Alzheimer's disease (AD). J Nutr Health Aging 2008; 12(1): 18-21. https://doi.org/10.1007/BF02982159
  7. Wengreen HJ, Neilson C, Munger R, Corcoran C. Diet quality is associated with better cognitive test performance among aging men and women. J Nutr 2009; 139(10): 1944-1949. https://doi.org/10.3945/jn.109.106427
  8. Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA. Mediterranean diet and mild cognitive impairment. Arch Neurol 2009; 66(2): 216-225. https://doi.org/10.1001/archneurol.2008.536
  9. Kim J, Yu A, Choi BY, Nam JH, Kim MK, Oh DH, et al. Dietary patterns and cognitive function in Korean older adults. Eur J Nutr 2015; 54(2): 309-318. https://doi.org/10.1007/s00394-014-0713-0
  10. Kim S, Choi BY, Nam JH, Kim MK, Oh DH, Yang YJ. Cognitive impairment is associated with elevated serum homocysteine levels among older adults. Eur J Nutr 2019; 58(1): 399-408. https://doi.org/10.1007/s00394-017-1604-y
  11. Kim SH, Park YM, Choi BY, Kim MK, Roh S, Kim K, et al. Associations of serum levels of vitamins A, C, and E with the risk of cognitive impairment among elderly Koreans. Nutr Res Pract 2018; 12(2): 160-165. https://doi.org/10.4162/nrp.2018.12.2.160
  12. Devore EE, Grodstein F, van Rooij FJ, Hofman A, Stampfer MJ, Witteman JC, et al. Dietary antioxidants and long-term risk of dementia. Arch Neurol 2010; 67(7): 819-825. https://doi.org/10.1001/archneurol.2010.144
  13. Llewellyn DJ, Lang IA, Langa KM, Melzer D. Vitamin D and cognitive impairment in the elderly U.S. population. J Gerontol A Biol Sci Med Sci 2011; 66(1): 59-65. https://doi.org/10.1093/gerona/glq185
  14. Selhub J, Miller JW. The pathogenesis of homocysteinemia: interruption of the coordinate regulation by S-adenosylmethionine of the remethylation and transsulfuration of homocysteine. Am J Clin Nutr 1992; 55(1): 131-138. https://doi.org/10.1093/ajcn/55.1.131
  15. Chei CL, Raman P, Yin ZX, Shi XM, Zeng Y, Matchar DB. Vitamin D levels and cognition in elderly adults in China. J Am Geriatr Soc 2014; 62(11): 2125-2129. https://doi.org/10.1111/jgs.13082
  16. van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 2011; 25(4): 671-680. https://doi.org/10.1016/j.beem.2011.06.007
  17. Jung IK. Prevalence of vitamin D deficiency in Korea: results from KNHANES 2010 to 2011. J Nutr Health 2013; 46(6): 540-551. https://doi.org/10.4163/jnh.2013.46.6.540
  18. Lim S, Shin H, Kim MJ, Ahn HY, Kang SM, Yoon JW, et al. Vitamin D inadequacy is associated with significant coronary artery stenosis in a community-based elderly cohort: the Korean Longitudinal Study on Health and Aging. J Clin Endocrinol Metab 2012; 97(1): 169-178. https://doi.org/10.1210/jc.2011-1580
  19. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001; 22(4): 477-501. https://doi.org/10.1210/edrv.22.4.0437
  20. Wilson VK, Houston DK, Kilpatrick L, Lovato J, Yaffe K, Cauley JA, et al. Relationship between 25-hydroxyvitamin D and cognitive function in older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 2014; 62(4): 636-641. https://doi.org/10.1111/jgs.12765
  21. Llewellyn DJ, Lang IA, Langa KM, Muniz-Terrera G, Phillips CL, Cherubini A, et al. Vitamin D and risk of cognitive decline in elderly persons. Arch Intern Med 2010; 170(13): 1135-1141. https://doi.org/10.1001/archinternmed.2010.173
  22. Moon JH, Lim S, Han JW, Kim KM, Choi SH, Kim KW, et al. Serum 25-hydroxyvitamin D level and the risk of mild cognitive impairment and dementia: the Korean Longitudinal Study on Health and Aging (KLoSHA). Clin Endocrinol (Oxf) 2015; 83(1): 36-42. https://doi.org/10.1111/cen.12733
  23. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary reference intakes for calcium and vitamin D. Washington, D.C.: National Academies Press; 2011.
  24. Lee JH, Lee KU, Lee DY, Kim KW, Jhoo JH, Kim JH, et al. Development of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries. J Gerontol B Psychol Sci Soc Sci 2002; 57(1): P47-P53. https://doi.org/10.1093/geronb/57.1.P47
  25. Lee DY, Lee KU, Lee JH, Kim KW, Jhoo JH, Kim SY, et al. A normative study of the CERAD neuropsychological assessment battery in the Korean elderly. J Int Neuropsychol Soc 2004; 10(1): 72-81. https://doi.org/10.1017/S1355617704101094
  26. Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, et al. Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr 2007; 61(12): 1435-1441. https://doi.org/10.1038/sj.ejcn.1602657
  27. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009; 20(11): 1807-1820. https://doi.org/10.1007/s00198-009-0954-6
  28. van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, et al. Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn Study. Am J Clin Nutr 2007; 85(3): 755-761. https://doi.org/10.1093/ajcn/85.3.755
  29. Kim BK, Jung HM, Kim YK, Kim SY, Kim JH. Serum 25-Hydroxy Vitamin D3 Analysis of Korean People. Korean J Nucl Med Tech 2010; 14(1): 133-137.
  30. Yu AR, Kim JH, Kwon OR, Oh SY, Kim JH, Yang YJ. Associations between serum 25-hydroxyvitamin D and consumption frequencies of vitamin D rich foods in Korean adults and older adults. Korean J Community Nutr 2014; 19(2): 122-132. https://doi.org/10.5720/kjcn.2014.19.2.122
  31. Tardelli VS, Lago MP, Silveira DX, Fidalgo TM. Vitamin D and alcohol: a review of the current literature. Psychiatry Res 2017; 248: 83-86. https://doi.org/10.1016/j.psychres.2016.10.051
  32. Wacker M, Holick MF. Sunlight and Vitamin D: a global perspective for health. Dermatoendocrinol 2013; 5(1): 51-108. https://doi.org/10.4161/derm.24494
  33. Kuhn T, Kaaks R, Teucher B, Hirche F, Dierkes J, Weikert C, et al. Dietary, lifestyle, and genetic determinants of vitamin D status: a cross-sectional analysis from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study. Eur J Nutr 2014; 53(3): 731-741. https://doi.org/10.1007/s00394-013-0577-8
  34. Thompson JM, Li T, Park MK, Qureshi AA, Cho E. Estimated serum vitamin D status, vitamin D intake, and risk of incident alopecia areata among US women. Arch Dermatol Res 2016; 308(9): 671-676. https://doi.org/10.1007/s00403-016-1687-y
  35. Ministry of Health and Welfare, The Korean Nutrition Society. Dietary reference intakes for Koreans 2015. Seoul: The Korean Nutrition Society; 2016. p.23-24.
  36. Yoo K, Cho J, Ly S. Vitamin D intake and serum 25-hydroxyvitamin D levels in Korean adults: analysis of the 2009 Korea National Health and Nutrition Examination Survey (KNHANES IV-3) using a newly established vitamin D database. Nutrients 2016; 8(10): 610. https://doi.org/10.3390/nu8100610
  37. Berwick M, Erdei EO. Vitamin D and melanoma incidence and mortality. Pigment Cell Melanoma Res 2013; 26(1): 9-15. https://doi.org/10.1111/pcmr.12015
  38. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985; 76(4): 1536-1538. https://doi.org/10.1172/JCI112134
  39. Vaes AM, Brouwer-Brolsma EM, van der Zwaluw NL, van Wijngaarden JP, Berendsen AA, van Schoor N, et al. Food sources of vitamin D and their association with 25-hydroxyvitamin D status in Dutch older adults. J Steroid Biochem Mol Biol 2017; 173: 228-234. https://doi.org/10.1016/j.jsbmb.2016.10.004
  40. Eyles DW, Smith S, Kinobe R, Hewison M, McGrath JJ. Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat 2005; 29(1): 21-30. https://doi.org/10.1016/j.jchemneu.2004.08.006
  41. Shin MY, Kwun IS, Vitamin D. Vitamin D: is it a vitamin or a hormone?. Food Ind Nutr 2012; 17(2): 1-6.
  42. Kalueff AV, Tuohimaa P. Neurosteroid hormone vitamin D and its utility in clinical nutrition. Curr Opin Clin Nutr Metab Care 2007; 10(1): 12-19. https://doi.org/10.1097/MCO.0b013e328010ca18
  43. Kennedy DO, Haskell CF. Vitamins and cognition: what is the evidence? Drugs 2011; 71(15): 1957-1971. https://doi.org/10.2165/11594130-000000000-00000
  44. McCann JC, Ames BN. Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction? FASEB J 2008; 22(4): 982-1001. https://doi.org/10.1096/fj.07-9326rev
  45. Buell JS, Scott TM, Dawson-Hughes B, Dallal GE, Rosenberg IH, Folstein MF, et al. Vitamin D is associated with cognitive function in elders receiving home health services. J Gerontol A Biol Sci Med Sci 2009; 64(8): 888-895.
  46. Lee DM, Tajar A, Ulubaev A, Pendleton N, O'Neill TW, O'Connor DB, et al. Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men. J Neurol Neurosurg Psychiatry 2009; 80(7): 722-729. https://doi.org/10.1136/jnnp.2008.165720
  47. Moon Y, Han SH. Vitamin D deficiency and cognitive dysfunction. Dement Neurocogn Disord 2012; 11(4): 111-117. https://doi.org/10.12779/dnd.2012.11.4.111
  48. Przybelski R, Agrawal S, Krueger D, Engelke JA, Walbrun F, Binkley N. Rapid correction of low vitamin D status in nursing home residents. Osteoporos Int 2008; 19(11): 1621-1628. https://doi.org/10.1007/s00198-008-0619-x
  49. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56(3): 303-308. https://doi.org/10.1001/archneur.56.3.303