Low vitamin D status, high bone turnover, and bone fractures in centenarians

A Narrative Review Exploring the Similarities between Cilento and the Already Defined "Blue Zones" in Terms of Environment, Nutrition, and Lifestyle: Can Cilento Be Considered an Undefined "Blue Zone"?

Longevity is rightly considered one of the greatest achievements of modern society, not only as a function of lifespan, but, more importantly, as a function of healthspan. There are Longevity Blue Zones (LBZs), regions around the world, such as in Okinawa, Japan; the Nicoya Peninsula, Costa Rica; Loma Linda, California; Icaria, Greece; and Ogliastra, Sardinia, that are characterized by a significant percentage of residents who live exceptionally long lives, often avoiding age-related disability to a significantly higher degree than in the Western way of life. Longevity is not a universal phenomenon, so if there are places in the world with characteristics similar to the LBZs, it is important to identify them in order to better understand what other factors, in addition to the known ones, might contribute to a long and healthy life. This narrative review aims to identify common factors between Cilento and the five LBZs, taking into account environmental, nutritional, and lifestyle factors. Articles from 2004 to the present, limited to studies published in English, German, and Italian, were searched in PubMed/Medline, Scopus, and Google Scholar. The co-authors agreed on 18 final reference texts. In order to evaluate the similarities between Cilento and the LBZs, a descriptive comparative approach was used. Cilento and the LBZs share several common factors, including a hilly altitude ranging from 355 to 600 m; a mild climate throughout the year, with temperatures between 17.4 and 23.5 degrees Celsius; traditional professions, such as agriculture and animal husbandry; and a predominantly Mediterranean or plant-based diet, with typical recipes based on legumes, tubers, vegetables, and extra virgin olive oil. Additionally, maintenance of strong intergenerational family relationships, religious devotion, and social relationships within the community are also prevalent. Given the similarities to Cilento, one might wonder if this is an LBZ waiting to be discovered. The lessons learned from this discovery could be applied to the general population to protect them from non-communicable chronic diseases and help slow the aging process.

Diet and longevity in the Blue Zones: A set-and-forget issue?

The Blue Zones (BZs) are areas of the globe inhabited by exceptionally long-lived populations. They include the island of Okinawa in Japan, the island of Ikaria in Greece, the mountain area of the island of Sardinia in Italy, and the peninsula of Nicoya in Costa Rica. Their longevity is a relatively recent phenomenon that has been progressively investigated since the dawn of this century. Research efforts over the past two decades have sought to shed light on the factors associated with this longevity, as well as explore the possibility of lessons transferable to the general population. Among the features of BZ inhabitants, described in the literature, their eating habits hold a prominent place, as these have the advantage of being easily quantifiable and applicable on a larger scale. However, it is too often taken for granted that the mere fact of being documented in a long-lived population makes the diet a causal factor of that population's longevity; this is a claim which should be proven. Furthermore, it is implicitly assumed that a specific BZ diet is homogeneous and remains stable over time, whereas some evidence suggests the opposite. Therefore, this review summarizes our current knowledge of the BZ diets and discusses whether they can be considered as a paradigmatic example of healthy nutrition valid for anyone or, rather, a set of evolving food patterns that has offered benefits to a few specific communities in recent decades.

Immunosenescence and inflammaging in the aging process: age-related diseases or longevity?

During aging the immune system (IS) undergoes remarkable changes that collectively are known as immunosenescence. It is a multifactorial and dynamic phenomenon that affects both natural and acquired immunity and plays a critical role in most chronic diseases in older people. For a long time, immunosenescence has been considered detrimental because it may lead to a low-grade, sterile chronic inflammation we proposed to call "inflammaging" and a progressive reduction in the ability to trigger effective antibody and cellular responses against infections and vaccinations. Recently, many scientists revised this negative meaning because it can be considered an essential adaptation/remodeling resulting from the lifelong immunological biography of single individuals from an evolutionary perspective. Inflammaging can be considered an adaptive process because it can trigger an anti-inflammatory response to counteract the age-related pro-inflammatory environment. Centenarians represent a valuable model to study the beneficial changes occurring in the IS with age. These extraordinary individuals reached the extreme limits of human life by slowing down the aging process and, in most cases, delaying, avoiding or surviving the major age-associated diseases. They indeed show a complex and heterogeneous phenotype determined by an improved ability to adapt and remodel in response to harmful stimuli. This review aims to point out the intimate relationship between immunosenescence and inflammaging and how these processes impact unsuccessful aging rather than longevity. We also describe the gut microbiota age-related changes as one of the significant triggers of inflammaging and the sex/gender differences in the immune system of the elderly, contributing to the sex/gender disparity in terms of epidemiology, pathophysiology, symptoms and severity of age-related diseases. Finally, we discuss how these phenomena could influence the susceptibility to COVID-19 infection.

Twelve-Week Daily Consumption of ad hoc Fortified Milk with ω-3, D, and Group B Vitamins Has a Positive Impact on Inflammaging Parameters: A Randomized Cross-Over Trial

Background and Aim: A state of chronic, subclinical inflammation known as inflammaging is present in elderly people and represents a risk factor for all age-related diseases. Dietary supplementation with ad hoc fortified foods seems an appealing strategy to counteract inflammaging. The purpose of this study was to test the efficacy of elderly-tailored fortified milk on inflammaging and different health parameters. Methods: A double-blind randomized cross-over study was performed on forty-eight volunteers aged 63–80 years. The fortified milk was enriched with ω-3 polyunsaturated fatty acids (eicosapentaenoic acid, EPA; docosahexaenoic acid, DHA), vitamins (25-hydroxyvitamin D, E, C, B6, B9, B12), and trace elements (zinc, selenium). The two intervention periods lasted for 12 weeks, with a 16-week washout intermission. Results: Compared to placebo, the consumption of fortified milk increased the circulating levels of different micronutrients, including vitamins and the ω-3 index of erythrocyte membranes. Conversely, it reduced the amount of arachidonic acid, homocysteine, and ω-6/ω-3 ratio. Conclusion: Twelve-week daily consumption of adhoc fortified milk has an overall positive impact on different health parameters related to inflammaging in the elderly.

Vitamin D in physiological and pathological aging: Lesson from centenarians

Vitamin D is a secosteroid hormone that exerts a pleiotropic action on a wide spectrum of tissues, apparatuses and systems. Thus, vitamin D has assumed an increasingly dominant role as a key determinant of biological mechanisms and specific clinical conditions. Older people frequently present vitamin D deficiency, a status potentially influencing several mechanisms responsible for different age-related diseases. Centenarians symbolize the ideal model for investigating the peculiar traits of longevity, as they have reached an age close to the estimated limit of the human lifespan. Interestingly, despite the profound heterogeneity of centenarians in terms of health status, all these people share the same condition of severe vitamin D deficiency, suggesting that they may have implemented a number of adaptive strategies to cope with the age-related physiological derangement of vitamin D metabolism. The lesson deriving from centenarians' experience suggests that: i) severe vitamin D deficiency does not preclude the possibility of reaching extreme longevity, ii) strategies to prevent hypovitaminosis D may be useful to slow down the processes of "fragilization" occurring in aged people, iii) beneficial effects of vitamin D supplementation need to be confirmed regarding longevity.

Sex, Residence and Fish Intake Predict Vitamin D Status in Chinese Centenarians

OBJECTIVES

This study aims to investigate the prevalence of vitamin D deficiency in Chinese centenarians and to identify the factors associated with vitamin D deficiency.

DESIGN

Cross-sectional population-based study.

SETTING

Hainan province in the south of China.

PARTICIPANTS

943 subjects aged 100 years old and older.

METHODS

Details on sociodemographics and lifestyle characteristics were collected using a structured questionnaire. Anthropometrics and blood samples were obtained. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D concentration < 20ng/mL (50nmol/L).

RESULTS

The overall prevalence of vitamin D deficiency among these 943 centenarians was 39.9% (376 subjects) and the mean serum vitamin D concentrations were 22.7±9.5 (ng/mL). Female centenarians had higher prevalence of vitamin D deficiency than male (44.0% vs. 21.7%, P <0.001). Multivariate logistic regression analyses showed that being female, urban residency, lower body mass index, higher serum parathyroid hormone levels, no fish consumption, and less sun exposure time were all significant and independent determinants of vitamin D deficiency. No significant associations of vitamin D deficiency with ethnic, education, geographic location, tea drinking, alcohol use, or smoking were found in this study.

CONCLUSION

Vitamin D deficiency was common in Chinese centenarians, especially in women. Given that vitamin D deficiency is linked to numerous adverse health outcomes, dietary, outdoor activities and other intervention measures are needed to correct vitamin D deficiency in this population.

Nutrition and Inflammation: Are Centenarians Similar to Individuals on Calorie-Restricted Diets?

Individuals capable of reaching the extreme limit of human life such as centenarians are characterized by an exceptionally healthy phenotype—that is, a low number of diseases, low blood pressure, optimal metabolic and endocrine parameters, and increased diversity in the gut microbiota—and they are epigenetically younger than their chronological age. We present data suggesting that such a remarkable phenotype is largely similar to that found in adults following a calorie-restricted diet. Interviews with centenarians and historical data on the nutritional and lifestyle habits of Italians during the twentieth century suggest that as children and into adulthood, centenarians lived in an environment that was nonobesogenic, but at the same time the environment did not produce malnutrition. Centenarians appear to be creatures of habit, and we argue that their habit of eating meals at the same time each day favored the maintenance of circadian rhythms, including their sleep cycle. Finally, we argue that centenarians’ chronic inflammatory status, which we dubbed inflammaging, is peculiar, likely adaptive, and less detrimental than in younger people.

Long-Term Effects of Dietary Protein and Branched-Chain Amino Acids on Metabolism and Inflammation in Mice

Aging is the main factor involved in the onset of degenerative diseases. Dietary protein restriction has been shown to increase the lifespan of rodents and improve metabolic phenotype. Branched-chain amino acids (BCAA) can act as nutrient signals that increase the lifespan of mice after prolonged supplementation. It remains unclear whether the combination of protein restriction and BCAA supplementation improves metabolic and immunological profiles during aging. Here, we investigated how dietary protein levels and BCAA supplementation impact metabolism and immune profile during a 12-month intervention in adult male C57BL/6J mice. We found that protein restriction improved insulin tolerance and increased hepatic fibroblast growth factor 21 mRNA, circulating interleukin (IL)-5 concentration, and thermogenic uncoupling protein 1 in subcutaneous white fat. Surprisingly, BCAA supplementation conditionally increased body weight, lean mass, and fat mass, and deteriorated insulin intolerance during protein restriction, but not during protein sufficiency. BCAA also induced pro-inflammatory gene expression in visceral adipose tissue under both normal and low protein conditions. These results suggest that dietary protein levels and BCAA supplementation coordinate a complex regulation of metabolism and tissue inflammation during prolonged feeding.

Healthy ageing: the natural consequences of good nutrition-a conference report

Many countries are witnessing a marked increase in longevity and with this increased lifespan and the desire for healthy ageing, many, however, suffer from the opposite including mental and physical deterioration, lost productivity and quality of life, and increased medical costs. While adequate nutrition is fundamental for good health, it remains unclear what impact various dietary interventions may have on prolonging good quality of life. Studies which span age, geography and income all suggest that access to quality foods, host immunity and response to inflammation/infections, impaired senses (i.e., sight, taste, smell) or mobility are all factors which can limit intake or increase the body's need for specific micronutrients. New clinical studies of healthy ageing are needed and quantitative biomarkers are an essential component, particularly tools which can measure improvements in physiological integrity throughout life, thought to be a primary contributor to a long and productive life (a healthy "lifespan"). A framework for progress has recently been proposed in a WHO report which takes a broad, person-centered focus on healthy ageing, emphasizing the need to better understand an individual's intrinsic capacity, their functional abilities at various life stages, and the impact by mental, and physical health, and the environments they inhabit.

A systematic review of vitamin D status in southern European countries

PURPOSE

Despite an acknowledged dearth of data on serum 25-hydroxyvitamin D (25(OH)D) concentrations from Southern European countries, inter-country comparison is hampered by inconsistent data reporting. The purpose of the current study was to conduct a systematic literature review of available data on serum 25(OH)D concentrations and estimate vitamin D status in Southern European and Eastern Mediterranean countries, both at a population level and within key population subgroups, stratified by age, sex, season and country.

METHODS

A systematic review of the literature was conducted to identify and retrieve scientific articles reporting data on serum 25(OH)D concentration and/or vitamin D status following standard procedures.

RESULTS

Data were extracted from 107 studies, stratified by sex and age group, representing 630,093 individuals. More than one-third of the studies reported mean 25(OH)D concentrations below 50 nmol/L and ~ 10% reported mean serum 25(OH)D concentrations below 25 nmol/L. Overall, females, neonates/ infants and adolescents had the higher prevalence of poor vitamin D status. As expected, there was considerable variability between studies. Specifically, mean 25(OH)D ranged from 6.0 (in Italian centenarians) to 158 nmol/L (in elderly Turkish men); the prevalence of serum 25(OH)D < 50 nmol/L ranged from 6.8 to 97.9% (in Italian neonates).

CONCLUSIONS

Contrary to expectations, there was a high prevalence of low vitamin D status in the Southern Europe and the Eastern Mediterranean regions, despite abundant sunshine. These data further emphasize the need for strategies, such as fortification of foods with vitamin D and/or vitamin D supplementation, which will be tailored to the needs of specific population groups with higher risk of insufficiency or deficiency, to efficiently tackle the pandemic of hypovitaminosis D in Europe.

Is Parental Longevity Associated With the Cardiovascular Risk and the Successful Aging of Their Offspring? Results From the Multinational MEDIS Study

The aim of the present study was to evaluate the role of parental longevity and parental cardiovascular disease (CVD) history in CVD risk and successful aging of a random sample of older adults living in the Mediterranean basin and who participated in the MEDiterranean Islands (MEDIS) study. During 2005 to 2011, 2663 elders were voluntarily enrolled. A multidimensional successful aging index consisting of 10 components was used. Paternal and maternal longevity was defined as those older participants of whom both parents lived above the age of 90. The burden of CVD-related factors (CVD-RFs) was calculated as the total score of 4 major CVD-RFs (range 0-4). After adjustment, parental longevity was inversely associated with the burden of CVD-RFs ( P = .04). Moreover, parental longevity was positively associated with the older adults' successful aging score (β-coefficient [95% confidence interval]: .38 [0.06-0.71]). Parent's long living was revealed as an important factor for successful aging and for reduced CVD risk, suggesting that further research is needed in the genetic predisposition of longevity.

Immune parameters identify Italian centenarians with a longer five-year survival independent of their health and functional status

Centenarians are rare and exceptional individuals characterized by a peculiar phenotype. They are the best example of healthy aging in humans as most of them have escaped or substantially delayed the onset of major age-related diseases. Within this scenario, the purpose of the present work was to understand if immune status is associated with survival and health status in centenarians. To this aim, 116 centenarians were concomitantly characterized for their immunological, health and functional status, and followed-up for five-year survival. On the basis of previous knowledge we focused on a core of fundamental and basic immune parameters (number of leukocytes, monocytes, total lymphocytes, CD3(+) T lymphocytes, CD4(+) helper T lymphocytes, CD8(+) cytotoxic T lymphocytes, CD19(+) B lymphocytes and plasma levels of IgM), and the most important findings can be summarized as follows: i. a hierarchical cluster analysis was able to define Cluster1 (88 centenarians) and Cluster2 (28 centenarians) characterized by low and high values of all these immune parameters, respectively; ii. centenarians of Cluster2 showed a statistically longer five-year survival and more favorable values of other important immune (naïve, activated/memory and effector/memory T cells) and metabolic (glycemia, insulin and HOMA-IR) parameters, in accord with previous observations that centenarians have a peculiar immune profile, a preserved insulin pathway and a lower incidence of type 2 diabetes; and iii. unexpectedly, parameters related to frailty, as well as functional and cognitive status, did not show any significant correlation with the immune clustering, despite being capable per se of predicting survival. In conclusion, high values of basic immunological parameters and important T cell subsets correlate with five-year survival in centenarians, independent of other phenotypic characteristics. This unexpected biological scenario is compatible with the general hypothesis that in centenarians a progressive disconnection and loss of biological coherence among the different functions of the body occur, where survival/mortality result from the failure of any of these domains which apparently follow an independent age-related trajectory.

Stem cells and aging from a quasi-immortal point of view

Understanding aging and how it affects an organism's lifespan is a fundamental problem in biology. A hallmark of aging is stem cell senescence, the decline of functionality, and number of somatic stem cells, resulting in an impaired regenerative capacity and reduced tissue function. In addition, aging is characterized by profound remodeling of the immune system and a quantitative decline of adequate immune responses, a phenomenon referred to as immune-senescence. Yet, what is causing stem cell and immune-senescence? This review discusses experimental studies of potentially immortal Hydra which have made contributions to answering this question. Hydra transcription factor FoxO has been shown to modulate both stem cell proliferation and innate immunity, lending strong support to a role of FoxO as critical rate-of-aging regulator from Hydra to human. Constructing a model of how FoxO responds to diverse environmental factors provides a framework for how stem cell factors might contribute to aging.

Oxidative stress and the ageing endocrine system

Ageing is a process characterized by a progressive decline in cellular function, organismal fitness and increased risk of age-related diseases and death. Several hundred theories have attempted to explain this phenomenon. One of the most popular is the 'oxidative stress theory', originally termed the 'free radical theory'. The endocrine system seems to have a role in the modulation of oxidative stress; however, much less is known about the role that oxidative stress might have in the ageing of the endocrine system and the induction of age-related endocrine diseases. This Review outlines the interactions between hormones and oxidative metabolism and the potential effects of oxidative stress on ageing of endocrine organs. Many different mechanisms that link oxidative stress and ageing are discussed, all of which converge on the induction or regulation of inflammation. All these mechanisms, including cell senescence, mitochondrial dysfunction and microRNA dysregulation, as well as inflammation itself, could be targets of future studies aimed at clarifying the effects of oxidative stress on ageing of endocrine glands.

Does the longevity of one or both parents influence the health status of their offspring?

According to the findings of some recent studies, the centenarians' offspring appear to represent a promising model for research on longevity and healthy aging. This study compares the health status and the functional status of three groups of subjects: 1. individuals with two long-lived parents (one of whom centenarian), 2. individuals with only one long-lived (centenarian) parent, and 3. individuals with no long-lived parents. The goal is to verify whether the centenarians' offspring display any advantage over the offspring of both non-long-lived parents and to evaluate whether the longevity of the non-centenarian parent provides a further advantage. A total of 374 subjects (mean age approximately 70 years) was examined. A threshold for longevity was established for non-centenarian parents through demographic data available for Italy (males surviving to at least 81 years of age and females to 87 years). The participants were assessed for their health and functional status by means of a standardized questionnaire and tests of physical performance. Data were analyzed using multivariate regression models adjusted for socio-demographic characteristics and risk factors for age-related pathologies. The results of the study show that centenarians' offspring have a better functional status, a reduced risk for several age-related pathologies and reduced drug consumption than the offspring of non-long-lived parents. In addition, the health status of centenarians' offspring does not appear to be influenced by the longevity of the second parent. It therefore seems possible to conclude that at ages around 70 years the genetic contribution to health status deriving from having one centenarian parent is not substantially improved if the other parent is also long-lived.

Vitamin D in acute stress and critical illness

PURPOSE OF REVIEW

The pleotropic effects of vitamin D on chronic diseases have received significant attention; however, its role in acute illness is less understood. The purpose of this review is to summarize the current evidence regarding the role of vitamin D in acute stress and critical illness.

RECENT FINDINGS

25-Hydroxyvitamin D levels may affect risk of developing acute illnesses (e.g. respiratory infections), and low concentrations are associated with unfavorable outcomes during critical care. Inflammatory changes alone do not explain the observed deterioration in vitamin D status following acute stress. Hemodilution, interstitial extravasation, decreased synthesis of binding proteins, and renal wasting of 25-hydroxyvitamin D, all appear to play a more significant role in the regulation of vitamin D status during critical illness.

SUMMARY

Single-point assessments of 25-hydroxyvitamin D following acute stress may provide an inaccurate assessment of vitamin D status. In such cases, measurement of binding proteins and free vitamin D metabolites may be essential to create a more realistic approximation of vitamin D status. Variations in patient responses to acute stress and critical illness may depend not only on the degree of systemic vitamin D insufficiency, but also on the individual tissue requirements.

Vitamin D and Major Chronic Illness

OBJECTIVE

To review the current literature regarding vitamin D insufficiency and supplementation in major illnesses.

DESIGN AND METHODS

We reviewed Pubmed-indexed, English language manuscripts from January, 2003 to June, 2012 using search terms related to vitamin D, all-cause mortality, cardiovascular disease, pulmonary disease, diabetes mellitus, and cancer.

OUTCOME MEASURES

Incidence of disease, risk ratios associated with 25-hydroxyvitamin D [25(OH)D] levels, and/or vitamin D supplementation schedules were documented.

RESULTS

Although 25(OH)D levels ≥20 ng/mL were often associated with improved health outcomes, evidence suggests that 25(OH)D levels ≥30 ng/mL may confer additional health benefits.

CONCLUSIONS

Based on the available evidence, vitamin D supplementation to restore 25(OH)D levels within a range of 30-50 ng/mL is reasonable in order to optimize potential benefits and minimize potential risks. This, of course, should be considered in the context of individual patient needs and co-morbidities.

Vitamin D safety and requirements

Vitamin D an ancient secosteroid is essential for mineral homeostasis, bone remodeling, immune modulation, and energy metabolism. Recently, debates have emerged about the daily vitamin D requirements for healthy and elderly adults, the safety and efficacy of long term supplementation and the role of vitamin D deficiency in several chronic disease states. Since this molecule acts as both a vitamin and a hormone, it should not be surprising that the effects of supplementation are multi-faceted and complex. Yet despite significant progress in the last decade, our understanding of vitamin D physiology and the clinical relevance of low circulating levels of this vitamin remains incomplete. The present review provides the reader with a comprehensive and up-to-date understanding of vitamin D requirements and safety. It also raises some provocative research questions.

Nutrition in centenarians

The oldest old are among the fastest growing segment of the population and it is important to understand not only the influence of modifiable lifestyle factors such as diet and nutrition on the achievement of exceptional longevity but also the role, if any, of these factors on maintaining optimal cognitive, mental and physical health into advanced age. This review summarizes studies of dietary intake and patterns of long-lived peoples and presents current knowledge of nutritional status of centenarians as determined with nutritionally relevant biomarkers, providing information on comparative levels of the various biomarkers between centenarians and older adult controls and on the prevalence and predictors of nutritional deficiencies in centenarians. The studies indicate that BMI and nutritional status as indicated by circulating levels of antioxidant vitamins, vitamin B12, folate, homocysteine and 25(OH) vitamin D of centenarians are quite heterogeneous and influenced by region of residency and many of the demographic, dietary and lifestyle factors that influence nutritional status in other older adults. While many of the studies have been small, convenience samples of relatively healthy community-dwelling centenarians, a few have population-based or included participants of varying cognitive functioning. These and future studies examining associations between nutritional status and cognitive, mental and physical function should be instrumental in determining the role of nutrition in promoting longevity and improving the quality of life in these exceptional survivors.

Asymptomatic severe hypocalcemia secondary to vitamin d deficiency in an elderly patient

Objective. To describe an asymptomatic presentation of severe hypocalcemia secondary to vitamin D deficiency in an elderly patient. Methods. We describe the presentation and clinical course of an elderly woman with asymptomatic severe hypocalcemia referred to an endocrinology clinic for hyperparathyroidism. Results. The patient is an 83-year-old Caucasian woman who presented to an endocrinology clinic for evaluation of hyperparathyroidism, with an intact PTH of 462 pg/mL (normal range 14-72 pg/mL). The same lab report included a serum calcium of 5.2 mg/dL (normal range 8-10.5 mg/dL). She displayed no signs or symptoms of hypocalcemia. Given the extreme severity of hypocalcemia and her age, she was hospitalized. Vitamin D deficiency was suspected and was subsequently confirmed with undetectable serum levels. The patient remained asymptomatic throughout her hospital stay. Total and ionized calcium levels at discharge were 7.2 mg/dL and 1.03 mmol/L (normal range 1.1-1.4 mmol/L), respectively. Conclusion. Physicians should exercise prudent management with respect to the vitamin D status of the elderly patient, as certain patients may exhibit severe hypovitaminosis D and hypocalcemia without apparent clinical symptoms.

Prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults

OBJECTIVE

This study aims to determine the prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults.

DESIGN AND METHODS

A total of 123 subjects, 56.9% males and 43.1% females, were recruited from a tertiary care hospital in Karachi, Pakistan. Questionnaires were administered to gather demographics; height, weight, and blood samples were also taken. For staging serum 25OHD, the cutoff values ≤50 nmol/L and 50.1-74.9 nmol/L were defined as deficiency and insufficiency, respectively.

RESULTS

The mean vitamin D level in the study subjects was 41.1±9.6 nmol/L. Of them, 90% had low serum 25OHD levels: 69.9% were deficient and 21.1% had insufficient levels of 25OHD. There was a significant negative correlation between serum 25OHD and iPTH levels.

CONCLUSION

The high prevalence of vitamin D deficiency and insufficiency showed that a high proportion of apparently healthy adults are at risk of developing musculoskeletal and other chronic diseases. Serum iPTH and serum 25OHD levels are better markers of this deficiency as compared to other markers.

Quantitative ultrasound in osteoporosis and bone metabolism pathologies

Quantitative ultrasound (QUS) has been introduced in the medical field for the study of bone tissue to identify changes in the tissue that could suggest the presence of osteoporosis and bone fragility. The ultrasound technique is simple, versatile, and its low cost and lack of ionizing radiation have led to the diffusion of this method worldwide. The present article is an overview of the most relevant developments in the field of quantitative ultrasound, in clinical and experimental settings. The advantages and limitations of the present technique and suggestions for its use in the clinical practice are reported.

Through ageing, and beyond: gut microbiota and inflammatory status in seniors and centenarians

BACKGROUND

Age-related physiological changes in the gastrointestinal tract, as well as modifications in lifestyle, nutritional behaviour, and functionality of the host immune system, inevitably affect the gut microbiota, resulting in a greater susceptibility to infections.

METHODOLOGY/PRINCIPAL FINDINGS

By using the Human Intestinal Tract Chip (HITChip) and quantitative PCR of 16S rRNA genes of Bacteria and Archaea, we explored the age-related differences in the gut microbiota composition among young adults, elderly, and centenarians, i.e subjects who reached the extreme limits of the human lifespan, living for over 100 years. We observed that the microbial composition and diversity of the gut ecosystem of young adults and seventy-years old people is highly similar but differs significantly from that of the centenarians. After 100 years of symbiotic association with the human host, the microbiota is characterized by a rearrangement in the Firmicutes population and an enrichment in facultative anaerobes, notably pathobionts. The presence of such a compromised microbiota in the centenarians is associated with an increased inflammatory status, also known as inflammageing, as determined by a range of peripheral blood inflammatory markers. This may be explained by a remodelling of the centenarians' microbiota, with a marked decrease in Faecalibacterium prauznitzii and relatives, symbiotic species with reported anti-inflammatory properties. As signature bacteria of the long life we identified specifically Eubacterium limosum and relatives that were more than ten-fold increased in the centenarians.

CONCLUSIONS/SIGNIFICANCE

We provide evidence for the fact that the ageing process deeply affects the structure of the human gut microbiota, as well as its homeostasis with the host's immune system. Because of its crucial role in the host physiology and health status, age-related differences in the gut microbiota composition may be related to the progression of diseases and frailty in the elderly population.

Vitamin B12 deficiency in African American and white octogenarians and centenarians in Georgia

OBJECTIVE

Test the hypotheses that vitamin B12 deficiency would be prevalent in octogenarians and centenarians and associated with age, gender, race/ethnicity, living arrangements (community or skilled nursing facility), animal food intake, B-vitamin supplement use, atrophic gastritis, folate status, and hematological indicators.

DESIGN

Population-based multi-ethnic sample of adults aged 80 to 89 and 98 and above.

SETTING

Northern Georgia in the United States.

PARTICIPANTS

Men and women aged 80 to 89 (octogenarians, n = 80) and 98 and older (centenarians, n = 231).

MEASUREMENTS

Wilcoxon signed-rank tests, Fisher's exact tests, and logistic regression analysis was used to examine the associations of vitamin B12 status with the variables of interest.

RESULTS

After excluding participants receiving vitamin B12 injections (n = 17), the prevalence of vitamin B12 deficiency was higher in centenarians than in octogenarians (35.3% vs. 22.8%, p < 0.05, defined as plasma vitamin B12 < 258 pmol/L and serum methylmalonic acid > 271 nmol/L and methylmalonic acid > serum 2-methylcitrate) and in both age groups was correlated with significantly higher homocysteine (p < 0.05) and lower plasma and red cell folate (p < 0.01), but was not related to hemoglobin, anemia, mean cell volume, or macrocytosis. In logistic regression analysis, the probability of being vitamin B12-deficient was significantly increased by being a centenarian vs. octogenarian (p < 0.03), by being white vs. African American (p < 0.02), by increasing severity of atrophic gastritis (p < 0.001), and by not taking oral B-vitamin supplements (p < 0.01), but was not related to gender, living arrangements, or animal food intake.

CONCLUSIONS

Centenarians and octogenarians are at high risk for vitamin B12 deficiency for many of the same reasons identified in other older adult populations. Given the numerous potential adverse consequences of poor vitamin B12 status, efforts are needed to ensure vitamin B12 adequacy in these older adults.

A weak link in metabolism: the metabolic capacity for glycine biosynthesis does not satisfy the need for collagen synthesis

In a previous paper, we pointed out that the capability to synthesize glycine from serine is constrained by the stoichiometry of the glycine hydroxymethyltransferase reaction, which limits the amount of glycine produced to be no more than equimolar with the amount of C 1 units produced. This constraint predicts a shortage of available glycine if there are no adequate compensating processes. Here, we test this prediction by comparing all reported fl uxes for the production and consumption of glycine in a human adult. Detailed assessment of all possible sources of glycine shows that synthesis from serine accounts for more than 85% of the total, and that the amount of glycine available from synthesis, about 3 g/day, together with that available from the diet, in the range 1.5-3.0 g/day, may fall significantly short of the amount needed for all metabolic uses, including collagen synthesis by about 10 g per day for a 70 kg human. This result supports earlier suggestions in the literature that glycine is a semi-essential amino acid and that it should be taken as a nutritional supplement to guarantee a healthy metabolism.

Serum 25-hydroxyvitamin D levels modulate the acute-phase response associated with the first nitrogen-containing bisphosphonate infusion

The acute-phase response (APR) is the most frequent side effect after the first dose of intravenous nitrogen-containing bisphosphonates (N-BPs). It has been demonstrated in vitro that N-BPs stimulate gammadelta T-cell proliferation and production of cytokines and that vitamin D is able to modulate them. Therefore, we have studied the relationship between bone metabolism parameters, particularly for 25-hydroxyvitamin D [25(OH)D], and APR in patients treated with 5 mg zoledronic acid intravenously. Ninety N-BP-naive osteoporotic women (63.7 +/- 10.6 years of age) were stratified for the occurrence of APR (APR(+)) or not (APR(-)) and quantified by body temperature and C-reactive protein (CRP). The APR(+) women had significantly lower 25(OH)D levels than the APR(-) women. Levels of 25(OH)D were normal (>30 ng/mL) in 31% of APR(+) women and in 76% of APR(-) women. The odds ratio (OR) to have APR in 25(OH)D-depleted women was 5.8 [95% confidence interval (CI) 5.30-6.29; p < .0002] unadjusted and 2.38 (95% CI 1.85-2.81; p < .028) after multiple adjustments (for age, body mass index, CRP, calcium, parathyroid hormone, and C-telopeptide of type I collagen). Levels of 25(OH)D were negatively correlated with postdose body temperature (r = -0.64, p < .0001) and CRP (r = -0.79, p < .001). An exponential increase in fever and CRP has been found with 25(OH)D levels lower than 30 ng/mL and body temperature less than 37 degrees C, whereas normal CRP was associated with 25(OH)D levels above 40 ng/mL. The association between post-N-BPs APR and 25(OH)D suggests an interesting interplay among N-BPs, 25(OH)D, and the immune system, but a causal role of 25(OH)D in APR has to be proven by a randomized, controlled trial. However, if confirmed, it should have some practical implications in preventing APR.

Vitamin d deficiency/insufficiency practice patterns in a veterans health administration long-term care population: a retrospective analysis

OBJECTIVES

To evaluate the prevalence of vitamin D deficiency/insufficiency in long-term care patients at a Veterans Health Administration (VHA) hospital and to assess treatment and follow-up of low vitamin D levels.

DESIGN

Observational cohort study.

SETTING

VA hospital extended care center (ECC).

PARTICIPANTS

2218 ECC patients between January 2001 and December 2006 were screened.

MEASUREMENT

Serum 25-hydroxyvitamin D (25[OH]D) level, vitamin D therapy regimen, time to follow-up, documented adverse event to vitamin D therapy.

RESULTS

Of 2218 patients admitted to the ECC during the study period, 229 (10%) had a vitamin D level measured. Among these 229 patients, 49% were vitamin D sufficient (25[OH]D > or =30 ng/mL), 14% were insufficient (25[OH]D=21-29 ng/mL), and 37% were deficient (25[OH]D < or =20 ng/mL). Sixty-nine percent of patients with low vitamin D levels received some form of vitamin D therapy, whereas 43% received treatment as well as follow-up evaluation of vitamin D status within 3 months. Only 13% received a formulation of vitamin D appropriate for the severity of their deficiency/insufficiency with concurrent calcium supplementation and had a repeat vitamin D level within 3 months.

CONCLUSION

Vitamin D levels were measured infrequently in long-term care patients. Among those monitored, the rate of vitamin D deficiency/insufficiency is high. Few patients with low vitamin D status received proper treatment and follow-up. These data support the need to educate physicians regarding the high prevalence of vitamin D insufficiency/deficiency among long-term care patients to ensure that patients with low vitamin D levels are identified and treated appropriately.

Low body mass index and declining sex steroids explain most age-related bone loss in Brazilian men

SUMMARY

Osteoporosis in men is underestimated, but our data point to an increasing prevalence rate in those over 70 years old with body mass index (BMI) <25 kg/m(2), bioavailable testosterone <2.7 nmol/L, bioavailable estradiol <40 pmol/L, and high bone turnover, defined in this study as serum carboxyterminal cross-linked telopeptide of type I collagen (ICTP) >4.3 microg/L.

INTRODUCTION

The association of sex steroids and osteoporosis was evaluated in 104 men, aged 50-93 years old.

METHODS

Bone mineral density (BMD), bone turnover (ICTP), testosterone (T), and estradiol (E(2)) were measured; free and bioavailable hormones (free testosterone index [FTI], BioT, free estradiol index [FEI], and BioE(2)) were calculated from T, E(2), sex hormone-binding globulin (SHBG), and albumin. Nonparametric analysis and Poisson regression models were used.

RESULTS

Significant increases in SHBG and ICTP and decreases in femoral neck BMD, FTI, FEI, BioT, and BioE(2) were observed with each additional decade of age. Femoral neck BMD was inversely correlated with ICTP, and both were significantly associated with SHBG, FTI, BioT, FEI, and BioE. There was a direct and graded association between age and osteoporosis prevalence rate (OP PR; p = 0.028). Compared to participants less than 70 years old, the crude OP PR of those 80 years and older was 3.2 (95%CI = 1.4-7.3). Adjusting sequentially for BMI and bioavailable sex hormones attenuated the association between age and osteoporosis prevalence by 55% and 77%, respectively.

CONCLUSION

Our data support the view that low BMI and declining sex steroids explain most of the association between aging, increased bone turnover, and osteoporosis in men.

Relationships of serum 25-hydroxyvitamin D to bone mineral density and serum parathyroid hormone and markers of bone turnover in older persons

CONTEXT

Serum 25-hydroxyvitamin D [25(OH)D] may influence serum PTH and other parameters of bone health up to a threshold concentration, which may be between 25 and 80 nmol/liter.

OBJECTIVE

The aim of the study was to assess the threshold serum 25(OH)D with regard to PTH, bone turnover markers, and bone mineral density (BMD).

DESIGN AND SETTING

This was part of the Longitudinal Aging Study Amsterdam, an ongoing cohort study.

PARTICIPANTS

A total of 1319 subjects (643 men and 676 women) between the ages of 65 and 88 yr participated in the study.

MAIN OUTCOME MEASURES

Serum 25(OH)D, PTH, osteocalcin, urinary deoxypyridinoline/creatinine, quantitative ultrasound of the heel, BMD of lumbar spine and hip, total body bone mineral content, and physical performance. The relationship between the variables was explored by analysis of covariance and the locally weighted regression (LOESS) plots.

RESULTS

Serum 25(OH)D was below 25 nmol/liter in 11.5%, below 50 nmol/liter in 48.4%, below 75 nmol/liter in 82.4%, and above 75 nmol/liter in 17.6% of the respondents. Mean serum PTH decreased gradually from 5.1 pmol/liter when serum 25(OH)D was below 25 nmol/liter to 3.1 pmol/liter when serum 25(OH)D was above 75 nmol/liter (P < 0.001) without reaching a plateau. All BMD values were higher in the higher serum 25(OH)D groups, although only significantly for total hip (P = 0.01), trochanter (P = 0.001), and total body bone mineral content (P = 0.005). A threshold of about 40 nmol/liter existed for osteocalcin and deoxypyridinoline/creatinine, 50 nmol/liter for BMD, and 60 nmol/liter for physical performance.

CONCLUSIONS

Low serum 25(OH)D concentrations are common in the elderly. Bone health and physical performance in older persons are likely to improve when serum 25(OH)D is raised above 50-60 nmol/liter.

Age, race and season predict vitamin D status in African American and white octogenarians and centenarians

OBJECTIVE

Poor vitamin D status has been associated with osteoporosis, falls, cardiovascular diseases, cancer, autoimmune diseases, pain, nursing home placement, and other age-related conditions, but little is known about the prevalence and predictors of vitamin D status in those aged 80 and older. Thus, this study tested the hypothesis that vitamin D status would be 1) poorer in a population-based multi-ethnic sample of centenarians as compared with octogenarians and 2) predicted by specific dietary, demographic or environmental factors.

DESIGN

Cross-sectional population-based analyses.

SETTING

Northern Georgia in the United States.

PARTICIPANTS

Men and women aged 80 to 89 (octogenarians, n=80) and 98 and older (centenarians, n=237).

MEASUREMENTS

Regression analyses were used to examine the associations of serum 25-hydroxyvitamin D [25(OH)D] with age, gender, race, living arrangements, dairy food intake, supplement intake, and season.

RESULTS

The prevalence of vitamin D insufficiency [25(OH)D<50 nmol/L] was higher in centenarians than in octogenarians (p<0.02). In logistic regression analyses, the risk of being vitamin D insufficient was significantly increased by being a centenarian vs. octogenarian (p<0.005) and by being African American vs. white (p<0.001) and decreased by taking a supplement with vitamin D (p<0.001) or by having vitamin D status measured in the summer or fall (each p<0.05), compared with spring.

CONCLUSIONS

Centenarians and octogenarians are at high risk for vitamin D insufficiency for many of the same reasons identified in younger populations. Given the numerous potential adverse consequences of poor vitamin D status, efforts are needed to ensure vitamin D adequacy in these older adults.

Human models of aging and longevity

BACKGROUND

The aging phenotype in humans is very heterogeneous and can be described as a complex mosaic resulting from the interaction of a variety of environmental, stochastic and genetic-epigenetic variables. Therefore, each old person must be considered as a singleton, and consequently the definition of 'aging phenotype' is very difficult.

OBJECTIVE

We discuss the phenotype of centenarians, the best example of successful aging, as well as other models exploited to study human aging and longevity, such as families enriched in long-living subjects, twins and cohorts of unrelated subjects.

METHODS

A critical review of literature available until March 2008.

CONCLUSIONS

No single model can be considered the gold standard for the study of aging and longevity, instead the combination of results obtained from different models must be considered in order to better understand these complex phenomena. We propose that a systems biology concept such as that of 'bow-tie' architecture, useful for managing information flow, could help in this demanding task.

Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures

We determined the prevalence of vitamin D deficiency and lower extremity function in women with hip fractures. Women with extremely low vitamin D levels had reduced lower extremity muscle function and increased falls 1 year later. Ensuring vitamin D sufficiency after a hip fracture may improve function and reduce falls.

INTRODUCTION

Hip fractures are the most devastating of fractures, commonly leading to loss of independent ambulation and living. In this retrospective analysis we determined the prevalence of vitamin D deficiency in women with hip fractures and the association between 25-hydroxyvitamin D [25(OH)D] levels and functional impairment one year later.

METHODS

One hundred ten community-dwelling women with hip fractures were recruited from Boston, MA (n = 30) and Baltimore, MD (n = 80) before 1998 and 25(OH)D levels were measured by radioimmunoassay. In a subset of women from Baltimore, a performance measure of the lower extremities using the lower extremity gain scale (LEGS) was measured at 2, 6, and 12 months. Falls, grip strength, chair rise time, walking speed, and balance were also determined.

RESULTS

Vitamin D insufficiency defined as a 25(OH)D <or=32 ng/mL was present in 96% of the women with hip fractures and 38% had extremely low levels <or=9 ng/mL. At 1 year post-fracture, compared to women with a 25(OH)D >9 ng/mL, those with 25(OH)D <or=9 ng/mL had poorer LEGS performance (p < 0.0001) and higher fall rates, without group differences in grip strength or balance.

CONCLUSION

Vitamin D sufficiency may have important effects on lower extremity function following hip fractures, without excessive healthcare costs.

Vitamin D deficiency: a common occurrence in both high-and low-energy fractures

As a consequence of newly elevated standards for normal vitamin D levels, there is a renewed interest in vitamin D insufficiency and deficiency (<32 and <20 ng/ml, respectively) in the orthopedic patient population. This study tests the hypothesis that vitamin D insufficiency is comparably prevalent among both high- and low-energy fracture patients. A retrospective analysis of the medical records for 44 orthopedic trauma in-patients with non-vertebral fractures was conducted from June 1, 2006 to February 1, 2007. The obtained data included a 25-hydroxyvitamin D level, age, gender, and reason for admission; high-energy vs. low-energy fracture. Vitamin D insufficiency, 25(OH)D <32 ng/ml, was found in 59.1% of the patients. Significantly, more women (75%) than men (40%) were vitamin D insufficient among all fracture patients and specifically among high-energy fractures, 80% women insufficient vs. 25% men insufficient. In women, both high- and low-energy fractures present with vitamin D insufficiency (80% of high-energy fractures and 71.4% of low-energy fractures). In men, the mean vitamin D level was lower for low-energy fractures (16 ng/ml) compared to high-energy fractures (32 ng/ml). In addition, men with low-energy fractures were significantly older than men with high-energy fractures and women with low-energy fractures were also older. Statistically, more vitamin D insufficiency is seen in women and our results are consistent with the gender difference seen in the general population. Even among younger men who sustain a high-energy fracture, 25% are vitamin D insufficient. Women with fractures regardless of age or fracture energy level have low vitamin D levels. Levels of 25(OH)D should be measured in all orthopedic trauma patients and the American Society for Bone and Mineral Research and National Osteoporosis Foundation currently recommend that vitamin D levels should be corrected.

Severe vitamin D deficiency in the institutionalized elderly

Severe vitamin D deficiency has been found to be prevalent in institutionalized elderly persons in several countries. The aim of the present work was to assess the vitamin D status of institutionalized elderly and compare it to that of community-living independent elderly in southern Greece during summer. Serum 25-hydroxyvitamin D [25(OH)D] and plasma PTH were measured in 58 (aged 68-103 yr, median 83.5) elderly inmates of a nursing home (IE) in the town of Kalamata (latitude N 37 degrees ) and in 48 (aged 60-89 yr, median 72) community-dwelling elderly (CDE) in Athens (latitude N 38 degrees ). The CDE had mean serum 25(OH)D 67.6 nmol/l [95% confidence interval (CI) 57.4 to 79.5], not far from the value of 80 nmol/l which is generally considered to be the lower limit of vitamin D sufficiency. The IE had significantly lower mean 25(OH)D 19.0 nmol/l (17.1 to 21.1); values of 25(OH)D below 20 nmol/l characterize severe vitamin D deficiency and may cause osteomalacia. The group of CDE had significantly lower mean plasma PTH 1.5 pmol/l (1.0 to 1.8) compared to 4.5 (3.9 to 5.3) of IE. Ninety percent of CDE had normal plasma PTH whereas 60% of IE had secondary hyperparathyroidism (PTH values >4.0 pmol/l). In conclusion, the majority of institutionalized elderly in southern Greece had severe vitamin D deficiency and secondary hyperparathyroidism in contrast to the fairly good vitamin D status and lack of hyperparathyroidism in the community-living elderly during summer. These findings indicate the need for vitamin D and calcium supplementation of the institutionalized elderly throughout the year.

Aging of the immune system as a prognostic factor for human longevity

Accumulating data are documenting an inverse relationship between immune status, response to vaccination, health, and longevity, suggesting that the immune system becomes less effective with advancing age and that this is clinically relevant. The mechanisms and consequences of age-associated immune alterations, designated immunosenescence, are briefly reviewed here.

Vitamin D in health and disease

Vitamin D functions in the body through both an endocrine mechanism (regulation of calcium absorption) and an autocrine mechanism (facilitation of gene expression). The former acts through circulating calcitriol, whereas the latter, which accounts for more than 80% of the metabolic utilization of the vitamin each day, produces, uses, and degrades calcitriol exclusively intracellularly. In patients with end-stage kidney disease, the endocrine mechanism is effectively disabled; however, the autocrine mechanism is able to function normally so long as the patient has adequate serum levels of 25(OH)D, on which its function is absolutely dependent. For this reason, calcitriol and its analogs do not constitute adequate replacement in managing vitamin D needs of such patients. Optimal serum 25(OH)D levels are greater than 32 ng/mL (80 nmol/L). The consequences of low 25(OH)D status include increased risk of various chronic diseases, ranging from hypertension to diabetes to cancer. The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D. (Both daily and intermittent regimens work well.) Serum 25(OH)D can be expected to rise by about 1 ng/mL (2.5 nmol/L) for every 100 IU of additional vitamin D each day. Recent data indicate that cholecalciferol (vitamin D(3)) is substantially more potent than ergocalciferol (vitamin D(2)) and that the safe upper intake level for vitamin D(3) is 10,000 IU/d.

Distribution and correlates of serum 25-hydroxyvitamin D levels in a sample of patients with hip fracture

BACKGROUND

Vitamin D deficiency is common in older populations, particularly during the winter months due to low levels of ultraviolet light exposure, and in nursing home residents.

OBJECTIVE

The main objective of the current study was to assess the distribution of serum 25-hydroxyvitamin D and its correlates in a sample of men and women with recent hip fractures who were part of a large clinical trial.

METHODS

This was a cross-sectional exploratory study of screened and ultimately randomized patients with hip fractures. They were part of a multinational (115 clinical centers in 20 countries), randomized, placebo-controlled, double-blind study testing the efficacy of a yearly IV bisphosphonate (zoledronic acid) in the prevention of new clinical fractures in patients with recent hip fracture repair. Levels of 25-hydroxyvitamin D, calcium, alkaline phosphatase, creatinine clearance, and albumin were measured at a screening visit using blood serum. Demographic variables were assessed by patient self-report. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry of the nonfractured hip.

RESULTS

This report included 1174 screened patients (526 with vitamin D measured) and 655 (385 with vitamin D measured) patients randomized before the protocol amendment. In screened patients, levels of 25-hydroxyvitamin D were low (median, 14.7 ng/mL; interquartilc range, 7.6, 21.65). Overall, 51% were at or below the clinically meaningful threshold of 15 ng/mL. Among those patients randomized, the level of 25-hydroxyvitamin D was significantly positively related to male sex (rho, 0.13; P < 0.05), serum calcium (rho, 0.16; P < 0.01), and BMD at the femoral neck (rho, 0.22; P < 0.01) in bivariate analyses. Low serum 25-hydroxyvitamin D (<15 ng/mL) was related only to low serum calcium (odds ratio, 0.16; 95% CI, 0.05-0.52) in multivariable logistic models controlling for sex, age, race, body mass index, living at home, alkaline phosphatase, and creatinine clearance.

CONCLUSIONS

We concluded that vitamin D insufficiency was a common problem in this population of elderly patients who had recently suffered a hip fracture. This insufficiency was related only to serum calcium in multivariable controlled models but cannot be reliably identified or excluded by measuring serum calcium alone. Physicians should be encouraged to check and monitor patients' serum levels of 25-hydroxyvitamin D.

Inflammaging as a major characteristic of old people: can it be prevented or cured?

Widespread aging at the population level is a recent phenomenon that emerged in affluent societies. Inflammation is necessary to cope with damaging agents and is crucial for survival, particularly to cope with acute inflammation during our reproductive years. But chronic exposure to a variety of antigens, especially to some viruses such as cytomegalovirus, for a period much longer than that predicted by evolution, induces a chronic low-grade inflammatory status that contributes to age-associated morbidity and mortality. This condition carries the proposed name "inflammaging". Centenarians are unique in that, despite high levels of pro-inflammatory markers, they also exhibit anti-inflammatory markers that may delay disease onset. The key to successful aging and longevity is to decrease chronic inflammation without compromising an acute response when exposed to pathogens.

Human longevity within an evolutionary perspective: The peculiar paradigm of a post-reproductive genetics

The data we collected on the genetics of human longevity, mostly resulting from studies on centenarians, indicate that: (1) centenarians and long-living sib-pairs are a good choice for the study of human longevity, because they represent an extreme phenotype, i.e., the survival tail of the population who escaped neonatal mortality, pre-antibiotic era illnesses, and fatal outcomes of age-related complex diseases. (2) The model of centenarians is not simply an additional model with respect to well-studied organisms, and the study of humans has revealed characteristics of ageing and longevity (geographical and sex differences, role of antigenic load and inflammation, role of mtDNA variants) which did not emerge from studies in laboratory model systems and organisms. (3) All the phenotypic characteristics of nonagenarians and centenarians fit the hypothesis that ageing is a remodelling process where the body of survivors progressively adapts to internal and external damaging agents they are exposed to during several decades, largely unpredicted by evolution. (4) Such a remodelling process, which can be considered a Darwinian process occurring at the somatic level within the framework of the evolutionary constraints, established by evolution for Homo sapiens as a species, may explain why the same gene polymorphism can have different (beneficial or detrimental) effects at different ages. (5) Geographic and demographic evidence suggest that longevity can be achieved by different combinations of genes, environment, and chance quantitatively and qualitatively different in many geographic areas, and that population-specific genetic factors, play a role on the longevity trait. (6) The concomitant and integrated use of new in silico and high throughput strategies will greatly accelerate the identification of new longevity genes in humans.

Prevalence of vitamin D depletion among subjects seeking advice on osteoporosis: a five-year cross-sectional study with public health implications

We assessed vitamin D nutritional status in unselected consecutive patients seeking advice on osteoporosis. The prevalence of vitamin D depletion ranged from 15-72% depending upon the cut-off levels used for serum 25-hydroxyvitamin D, and the prevalence did not change over the 5 years of the study.

INTRODUCTION

Vitamin D depletion is a significant public health problem and has been studied in different populations using different cut-off levels, but the optimal level is yet to be established.

METHODS

In a cross-sectional study of 2,924 patients seen for osteoporosis advice we determined the prevalence of vitamin D depletion, as assessed by 25-hydroxyvitamin D (25-OHD), using three different cut-off levels stratified by gender, race and the year of the study over 5 years.

RESULTS

Mean age was 68.3 +/- 10.0 years; 90% women and 88% white. Mean 25-OHD level was 24.6 +/- 10 ng/ml and mean PTH was 48.4 +/- 32 pg/ml. The prevalence of vitamin D depletion was 15% with a cut-off level of <15 ng/ml, and rose to 32% and 72% with cut-off levels <20 ng/ml and <30 ng/ml, respectively. The prevalence was higher in men and blacks and remained constant over 5 years, regardless of the cut-off level. The expected inverse relationship between 25-OHD and PTH was observed irrespective of gender or ethnicity.

CONCLUSIONS

The prevalence of vitamin D depletion in patients seeking advice for osteoporosis is high and did not change over the 5 years of the study.

Advances in the medical management of osteoporosis

Osteoporosis is a skeletal disorder characterised by compromised bone strength predisposing to increased risk of fracture, which is rapidly reaching epidemic proportions as the population ages. Many patients presenting with a fracture caused by a fall from standing height or less are not on any kind of therapy and many patients who sustain these fragility fractures are not started on therapy by their orthopaedic surgeon. In 2004, the United States Surgeon General released a report on osteoporosis recommending that physicians adopt a pyramidal approach to therapy. The base of the pyramid includes calcium, vitamin D, physical therapy and fall prevention. The second level calls for management or elimination of secondary causes of osteoporosis. The third level consists of treatment with either anti-resorptive or anabolic medications. The orthopaedic surgeon is in an ideal position to diagnose fragility fractures and suggest treatment in the hope of preventing future fractures. Anti-resorptive and anabolic therapies currently available are discussed.

Review on immunosenescence

The improvements of socio-environmental conditions, medical care and quality of life have caused a general improvement in the health status of the population and a consequent reduction of morbidity and mortality, resulting in an overall increased life-expectancy. The role of immunosenescence was negligible in the past, when the human lifespan was 40–50 years, and its impact on morbidity and mortality has emerged in combination with the extension of lifespan. Immunosenescence results from multifactorial processes that act on all components of the immune system. The changes associated with immunosenescence are playing an increasingly important role in the emergence of a series of age-related pathologies, conditioning the present epidemiology of old people.

Abnormalities of vitamin D and calcium metabolism after surgical treatment of morbid obesity: a study of 136 patients

OBJECTIVE

To assess the effect of bariatric surgical treatment of morbid obesity on bone mineral metabolism.

METHODS

We analyzed pertinent vitamin D and calcium metabolic variables in 136 patients who had undergone a malabsorptive bariatric operation. Measurements of bone mineral density (BMD), serum 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D [1,25-(OH)2D], parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase were performed. Statistical analyses assessed correlations among various factors.

RESULTS

The mean age (+/-SD) of the study group was 48.34 +/- 10.28 years. Their mean weight loss was 114.55 +/- 45.66 lb, and the mean duration since the bariatric surgical procedure was 54.02 +/- 51.88 months. Seventeen patients (12.5%) had a T-score of -2.5 or less, and 54 patients (39.7%) had a T-score between -1.0 and -2.5. Of 119 patients in whom serum 25-OHD was measured, 40 (34%) had severe hypovitaminosis D (25-OHD <8ng/mL), and 50 patients (42%) had low hypovitaminosis D (serum 25-OHD 8 to 20 ng/mL). The magnitude of weight loss correlated negatively with serum 25-OHD, calcium, phosphorus, and calcium x phosphorus product values and positively with serum alkaline phosphatase level. Serum 25-OHD and calcium concentrations correlated positively with the BMD. PTH, serum 1,25-(OH)2D, and alkaline phosphatase concentrations correlated negatively with the BMD, a reflection of the presence of secondary hyperparathyroidism, an accelerated conversion of 25-OHD to 1,25-(OH)2D by the elevated PTH levels, and increased osteoblastic activity. The mean daily vitamin D supplementation was 6,472 +/- 9,736 IU.

CONCLUSION

Hypovitaminosis D and subsequent bone loss are common in patients who have undergone a bariatric surgical procedure for morbid obesity. These patients require rigorous vitamin D supplementation.

Calcium metabolism and vitamin D in the extreme longevity

Skeletal remodelling is a continuous process during life and is still active also in extreme senescence. In the elderly, bone resorption often prevails over bone formation, causing bone loss and fragility. Elderly subjects are exposed to the risk of fractures, and loss of self-sufficiency, if considering that the proximal femur is the most frequently involved site. Bone remodelling can maintain circulating calcium within physiological ranges, at the expense of a substantial loss of this ion from the skeleton, particularly during senescence. Calcium metabolism is regulated at cellular/molecular level by a network of cytokines, growth factors, systemic hormones that act on bone in paracrine/autocrine/systemic fashion. Among the molecules involved in bone metabolism, parathyroid hormone (PTH) and vitamin D present some peculiar aspects during senescence. The osteometabolic features in a consistent group of centenarians have been evaluated. It results that a severe hypovitaminosis D was present in 99 out of 104 centenarians (25-OH vitamin D below 5 nmol/L), and that it plays an important role as a factor inducing a vicious circle involving hypocalcemia, secondary hyperparathyroidism, together with biochemical features indicating a consistent bone loss. Serum C-terminal cross-linking telopeptide, a specific marker of bone resorption was elevated in 92% of these subjects. Moreover, it has been found that several femoral fractures had occurred after 90 years of age. These data offer a rational for the possible prevention of elevated bone turnover, bone loss and consequently the reduction of osteoporotic fractures and fractures-induced disability, in the oldest olds, through the simple supplementation with calcium and vitamin D.