Vitamin D and Its Relationship with Obesity and Muscle
Table 1
Effect of vitamin D on muscle strength and falls.
Author, year, and study type
Patients, age
Endpoints/tools
Result
Visser et al., 2003 [73]; prospective observational study
1008 for grip strength evaluation; 331 for muscle mass evaluation; 55–85 yrs
Grip strength; appendicular skeletal muscle mass (using dual-energy X-ray absorptiometry)
(i) Persons with baseline 25-OHD levels <25 nmol/liter were 2.57 (based on grip strength) and 2.14 (based on muscle mass) times more likely to experience sarcopenia, compared with those with levels >50 nmol/liter (ii) PTH >4.0 pmol/liter was associated with an increased risk of sarcopenia
Falls, physical performance (isometric knee extensor strength), and self-rated function
No effect of vitamin D (calciferol, 300,000 IU) on physical health, falls, and physical performance, even in patients with baseline vitamin D levels <12 ng/mL
Upper and lower extremity muscle strength and power (using a leg press and handgrip strength), physical performance (specific tests), and activity (using questionnaires)
(i) Baseline 25OHD correlated with baseline single-leg stance time and physical activity score. Baseline PTH levels correlated with baseline 8-foot walk time and physical activity score (ii) No significant difference in strength, power, and physical performance between groups (cholecalciferol 1,000 IU/d or placebo for 6 months, all received 500 mg of calcium)
Broe et al., 2007 [75]; secondary data analysis of a previous RCT*
124 nursing-home residents; 68–104 yrs
Falls
Supplementation with 800 IU of cholecalciferol reduced the adjusted-incidence rate ratio of falls by 72%, compared to placebo; no differences for the 200, 400, and 600 IU dose
Bischoff-Ferrari et al., 2004 [78]; population-based survey
Ambulatory population; 60–90 yrs
Lower-extremity function; timed 8-foot walk test; and repeated sit-to-stand test
The group in the highest quintiles of 25(OH)D had an average decrease of 0.27 s in the 8-foot walk test and an average decrease of 0.67 s in the sit-to-stand test
Gerdhem et al., 2005 [77]; prospective observational study
986; 75.0–75.9 yrs
Gait, balance, and self-estimated activity level thigh muscle strength
25OHD correlated with gait speed (), balance test (), self-estimated activity level (), and thigh muscle strength ()
Houston et al., 2007 [81]; post hoc analysis of a prospective population-based study
976; 65 yrs or older
Short physical performance battery (SPPB) and handgrip strength
(i) Vitamin D levels were significantly associated with SPPB score in men () and handgrip strength in men () and women () (ii) Men and women with serum 25OHD <25.0 nmol/L had significantly lower SPPB score; and those with serum 25OHD <50 nmol/L had significantly lower handgrip strength than those with serum 25OHD ≥25 and ≥50 nmol/L, respectively, () (iii) PTH was significantly associated with handgrip strength only ()
Pfeifer et al., 2009 [91]; double-blind, controlled trial
242 community-dwelling people; 70 yrs or older
Falls, body sway, timed-up-and-go test, and maximum isometric leg extensor strength (assessed with a strain gauge dynamometer)
(i) Calcium plus vitamin D significantly decreased the number of subjects with first falls of 27% at month 12 and 39% at month 20, compared to calcium alone (ii) Significant improvements in quadriceps strength of 8%, a decrease in body sway of 28%, and a decrease in time needed to perform the TUG test of 11%
Moreira-Pfrimer et al., 2009 [92]; prospective, double-blind, placebo-controlled, randomized trial
46 patients in long-stay geriatric care, 62–94 years
Maximum isometric strength of hip flexors (SHF) and knee extensors (SKE), measured by a portable mechanical dynamometer
SHF was increased in the calcium/vitamin D group (1 g calcium + cholecalciferol 150,000 IU once a month for the first 2 months and then 90,000 IU once a month for the last 4 months) by 16.4% () and SKE by 24.6% (), no improvement in the calcium + placebo group
Total body lean and fat mass (DXA∧), midfemur muscle cross-sectional area (quantitative computed tomography), muscle strength, and physical function
Daily consumption of low-fat fortified milk (providing 1000 mg calcium and 800 IU vitamin D3, per day) does not enhance the effects of resistance training exercise on skeletal muscle size, strength, or function
Bischoff-Ferrari et al., 2009 [96]; meta-analysis of RCT*
2426 patients from 8 RCT
Falls
(i) High dose supplemental vitamin D reduced fall risk by 19% (ii) Achieved serum 25 (OH)D concentrations of 60 nmol/L or more resulted in a 23% fall reduction
Lips et al., 2010 [94]; double-blind, placebo-controlled trial
126 patients with vitamin D insufficiency; 70 yrs or older
Mediolateral body sway and short physical performance battery (SPPB)
(i) After 16 wk, mediolateral sway and SPPB did not differ significantly between treatment groups (vitamin D3 8400 IU/week versus placebo) (ii) In the post hoc analysis treatment with vitamin D3 significantly reduced sway compared with placebo () in patients with elevated baseline sway
Gupta et al., 2010 [90]; double-blind, randomized trial
40 healthy volunteers; 20–40 yrs
Handgrip and gastrosoleus dynamometry, pinch-grip strength, respiratory pressures, 6-minute walk test, and muscle energy Metabolism on magnetic resonance spectroscopy
The supplemented group (60,000 IU D3/week for 8 weeks followed by 60,000 IU/month for 4 months + 1 g of calcium daily) gained a handgrip strength of 2Æ4 kg; gastrosoleus strength of 3Æ0 Nm; and walking distance of 15Æ9 m over the placebo group
Vitamin D use was associated with statistically significant reduction in the risk of falls (odds ratio for suffering at least one fall, 0.86; 95% confidence interval, 0.77–0.96)
Handgrip and pinch grip strength and distance walked in 6 min
Mean handgrip strength and its increase were comparable in 4 groups (double placebo, calcium/placebo, cholecalciferol/placebo, and cholecalciferol/calcium at 6 months)
Cipriani et al., 2013 [100]; prospective intervention study
18 women with vitamin D deficiency (25–39 yrs)
Handgrip strength (using a dynamometer and evaluating maximal voluntary contraction (MVC) and speed of contraction ())
(i) No significant change in MVC and values after vitamin D supplementation (cholecalciferol 600,000 IU) (ii) A significant correlation between MVC and and serum phosphorus after supplementation ( and , resp.)
251 healthy adults with vitamin D deficiency (18–50 yrs)
Jump height, handgrip strength, and chair-rising test
(i) Percentage change in jump height did not differ between the group receiving vitamin D3 (1000 IU daily) and placebo () (ii) No significant effect of vitamin D on handgrip strength or the chair-rising test
