Fatigue and Vitamin D Status in Frail Elderly with and without Cancer, and Healthy Controls of Different Ages: Results from the IMAGE Study.

INTRODUCTION

Vitamin D deficiency has previously been shown to be associated with cancer-related fatigue. If vitamin D deficiency affects fatigue in frail elderly has not been studied before. The aim of this study was to investigate associations between vitamin D, fatigue, frailty, and sarcopenia in frail elderly with cancer (FEC) and without cancer (FE) in comparison with healthy controls.

METHODS

Baseline data from the "IMmunity and AGE" (IMAGE) study were used. IMAGE is an observational, prospective study originally designed to study immunity in frail elderly. In this study, data on self-assessed fatigue (0-10), vitamin D, and muscle strength at baseline were used. Four groups were included: (1) healthy elderly (HE) ≥65 years old with a score of 1-3 on Clinical Frailty Scale (CFS); (2) FE ≥65 years old (CFS 4-9); (3) with advanced cancer (FEC); and (4) healthy controls 18-64 years old (HY).

RESULTS

A total of 273 participants were included. HE had significantly higher vitamin D levels compared to FE and FEC, median 82 nmol/L compared to 54 and 47 nmol/L (p < 0.001 for both). FE and FEC were more fatigued, median 5 (IQR 4-8) and 7 (IQR 5-8), compared to HE, median 2 (IQR 0-4) (p < 0.001 for both). Regression models showed that low vitamin D was associated with increased fatigue (p < 0.001), frailty (p < 0.001), and reduced muscle strength (p < 0.05).

CONCLUSION

Fatigue was common in frail elderly, with or without cancer, and was associated with low vitamin D. Vitamin D deficiency was associated with increasing frailty and reduced muscle strength.