• 在25871名VITAL试验参与者中,其中25057名中老年人(50.7%为女性)有足够的数据来计算衰弱指数,他们的平均虚弱评分为0.109,3174人(12.7%)虚弱;
  • 在平均5年的随访期间,平均虚弱评分增加到 0.121,维生素D3( 2000 IU/d)和Ω-3 脂肪酸(1g/d)补充均不影响平均虚弱评分随时间的变化或平均虚弱评分的变化率;
  • 本研究结果尚不支持在社区居住的老年人中常规使用维生素D3或Ω-3脂肪酸补充剂来预防虚弱。
世界范围内老龄人口的迅速增加使得识别潜在的预防虚弱的策略变得更加紧迫。虚弱的流行程度随着年龄的增长而增加,据估计,85岁及以上的成年人中有多达一半的人生活在虚弱之中。慢性炎症是导致虚弱的主要假设机制,但抗炎药物和补充剂是否能降低虚弱的风险仍不确定。近期发表于JAMA Network Open的一项研究表明,与安慰剂相比,补充维生素D3或omega-3脂肪酸的治疗不影响衰弱的变化率或发病率。
JAMA Network Open [IF:13.353]

Effect of Vitamin D3 and Omega-3 Fatty Acid Supplementation on Risk of Frailty - An Ancillary Study of a Randomized Clinical Trial

维生素 D3 和Ω-3脂肪酸补充剂对虚弱风险的影响 - 一项随机临床试验的辅助研究


09-13, Article

Abstract & Authors:展开

Importance: Preventive strategies for frailty are needed. Whether supplements with anti-inflammatory properties, such as vitamin D3 or marine omega-3 fatty acids, are useful for frailty prevention is unknown.
Objective: To test the effects of vitamin D3 and omega-3 supplements on change in frailty in older individuals.
Design, Setting, and Participants: This study was conducted in 2021, as a prespecified ancillary to the Vitamin D and Omega-3 (VITAL) trial, a 2 × 2 factorial randomized clinical trial. A total of 25 871 individuals (men aged ≥50 years and women aged ≥55 years), without cancer or cardiovascular disease and with data on frailty, were recruited across all 50 US states from November 2011 to March 2014 and followed up through December 31, 2017. Data analysis for the ancillary study was conducted from December 1, 2019, to March 30, 2022.
Interventions: Vitamin D3, 2000 IU/d, and marine omega-3 fatty acids, 1 g/d.
Main Outcomes and Measures: Frailty was measured using a validated 36-item frailty index that includes measures of function, cognition, mood, and comorbidities from annual questionnaires. Change in frailty score from baseline to year 5, according to randomization, using an intention-to-treat protocol, was assessed using repeated measures. Cox proportional hazards regression models assessed incident frailty. In subgroup analysis, an alternative frailty definition, the physical phenotype, was used as a sensitivity analysis.
Results: Of 25 871 VITAL trial participants randomized, 25 057 had sufficient data to calculate a frailty index. Baseline mean (SD) age was 67.2 (7.0) years, and 12 698 (50.7.%) were women. Mean (SD) frailty score was 0.109 (0.090) (range, 0.00-0.685), and 3174 individuals (12.7%) were frail. During a median 5-year follow-up, mean (SD) frailty scores increased to 0.121 (0.099) (range, 0.00-0.792). Neither vitamin D3 nor omega-3 fatty acid supplementation affected mean frailty scores over time (mean difference at year 5: vitamin D3, −0.0002; P = .85; omega-3 fatty acid, −0.0001; P = .90) or rate of change in mean frailty score (interaction with time: vitamin D3; P = .98; omega-3 fatty acid; P = .13) Incident frailty remained similar over time (interaction with time: vitamin D3, P = .90; omega-3 fatty acid; P = .32). Results were unchanged using the frailty physical phenotype.
Conclusions and Relevance: In this ancillary study of the VITAL randomized clinical trial, treatment with vitamin D3 or omega-3 fatty acid supplementation, compared with placebo, did not affect the rate of frailty change or incidence over time. These results do not support routine use of either vitamin D3 or omega-3 fatty acid supplementation for frailty prevention in generally healthy community-dwelling older adults not selected for vitamin D3 deficiency.

First Authors:
Ariela R Orkaby

Correspondence Authors:
Ariela R Orkaby

All Authors:
Ariela R Orkaby,Rimma Dushkes,Rachel Ward,Luc Djousse,Julie E Buring,I-Min Lee,Nancy R Cook,Meryl S LeBoff,Olivia I Okereke,Trisha Copeland,JoAnn E Manson