Archives of Gerontology and Geriatrics 50 Suppl. 1 (2010) S17–S21 Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Vitamin D insufficiency and frailty syndrome in older adults living in a Northern Taiwan community Ching-I Chang a , Ding-Cheng (Derrick) Chan b , Ken-N Kuo c , Chao Agnes Hsiung d , Ching-Yu Chen a,e, * a Division of Geriatric Research, Institute of Population Health Sciences, National Health Research Institutes, 100 R440, 4F, No. 17 Xu-Zhou Road, Taipei, Taiwan b Department of Geriatrics and Gerontology, National Taiwan University Hospital, 100 No. 1 ChangDe St., Taipei, Taiwan c Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, 350 No. 35 Keyan Road, Zhunan, Miaoli, Taiwan d Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, 350 No. 35 Keyan Road, Zhunan, Miaoli, Taiwan e Department of Family Medicine, College of Medicine, National Taiwan University, 100 No. 1 Sec 1, Jen-Ai Road, Taipei, Taiwan article info Keywords: Vitamin D insufficiency Fried Frailty Index Edmonton Frail Scale Elderly in Taiwan abstract This study explored the association between vitamin D insufficiency and frailty syndrome defined by the Fried Frailty Index (FFI) and the Edmonton Frail Scale (EFS) in a northern Taiwan community. Data of 215 subjects participating in an integrated interventional trial involving community-dwelling older adults with a high frailty risk were analyzed. Subjects were first screened by telephone interview and then evaluated at a local hospital with questionnaires, physical performance tests, and serum 25(OH)D measurements. Of the 215 participants, 31% had 25(OH)D insufficiency (<20 ng/ml). Frail subjects based on the FFI were older, had lower Mini- Mental Status Exam (MMSE) scores, Barthel Index (BI) scores, and 25(OH)D levels. Using the EFS, frailer cases were more likely to be female, have less education, higher comorbid conditions, lower MMSE scores, lower Barthel Index scores, and lower 25(OH)D levels. The associations between insufficient 25(OH)D status and both frailty scales were significant. After adjustment of variables, the odds ratio of 25(OH)D insufficiency was 10.74 (95% CI 2.60–44.31) for frail versus robust individuals. The prevalence of vitamin D insufficiency was high in this population. There was a strong association between vitamin D insufficiency and the FFI. Vitamin D measurements and supplements are suggested for high-risk older people. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Frailty can be described as “a biological syndrome of decreased reserve (energy, physical ability, cognition, health) and resistance to stressors, resulting from cumulative declines across multiple physiological systems and causing vulnerability to adverse outcomes” (Fried et al., 2001). Older people with frailty are at increased risk for adverse health outcomes, including lost functional abilities and frequent hospitalizations (Rockwood et al., 1999; Fried et al., 2001). It is widely accepted that frailty is multidimensional, heterogeneous, and unstable, thus distinguishing it from disability or aging alone (Hogan et al., 2003). However, many instruments have been developed to measure frailty without a unifying classification system (Fried et al., 2001; Rockwood et al., 2005; Rolfson et al., 2006; Abellan van Kan et al., 2008). The instrument proposed by Fried et al. (2001), the FFI, following the Cardiovascular Health Study, classified subjects into three *Corresponding author. Division of Geriatric Research, Institute of Population Health Sciences, National Health Research Institutes, 100 R440, 4F, No. 17 Xu-Zhou Road, Taipei, Taiwan. Tel.: +(886-2)-3393-2198; fax: +(886-2)-2356-3260. E-mail address: chency@nhri.org.tw (C-Y. Chen). categories based on five indicators. It is one of the most widely used instruments in the research setting with emphasis on the physical domain (Abellan van Kan et al., 2008). Other instruments measure deficiencies in other areas such as cognition, burden of medical illness, and quality of life. For example, the EFS classifies subjects into five categories based on 10 domains (11 indicators) (Rolfson et al., 2006; Abellan van Kan et al., 2008) . Vitamin D, hydroxylated in the liver into 25-hydroxyvitamin D [25(OH)D], increases the absorption of calcium and phosphate needed for mineralization of the skeleton (Lips, 2001). Low 25(OH)D increases the risk of falls (Bischoff-Ferrari et al., 2004, 2005; Snijder et al., 2006), fractures (Bischoff-Ferrari et al., 2005), bone pain (Atherton et al., 2009; Lips, 2001; Mascarenhas and Mobarhan, 2004; Bischoff-Ferrari et al., 2005), muscle weakness (Bischoff-Ferrari et al., 2004; Gerdhem et al., 2005), sarcopenia (Visser et al., 2003), and disability (Lips, 2001). Recent studies have suggested that vitamin D may play some role in immunomodulation, infectious disease prevention, and psychiatric disorders (particularly depression) (Adams and Hewison, 2008; Hoogendijk et al., 2008). Low 25(OH)D levels are common in the elderly due to decreased vitamin synthesis in the skin, insufficient sunlight exposure, and deficient dietary supplementation (Holick 0167-4943 /$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.