Vitamin K status and mobility in older adults

reference

Shea Mk, Kritchevsky SB, Loeser RF, stand Sl. Vitamin K status and exposure to mobility and disability in older adults: the study on health, aging and body composition [Published Online Ahead of Print May 6, 2019]. (Link removed).

Study goal

to determine whether vitamin K deficiency (as a phyllochinone) can be a risk factor for restricted mobility and disability in older adults.

draft

prospective longitudinal cohort study

participant

The study included 1,323 participants (635 men, 688 women) with an average age of 74.6 ± 2.8 years. 40 % were African Americans, 60 % Caucasians.

study parameters evaluated

1. Objective parameters:

a. Output splasm phyllochinone (vitamin K) and subcarboxylated matrix glycoprotein (UCMGP; mirrors correlate the vitamin K status)
b. Serumtriglyceride
c. Interleukin-6 (IL-6)
d. Glomerular filtration rate (GFR)

2. Subjective parameters:

a. Index for healthy eating (HEA)
b. Mobility restriction: Defined as 2 successive semi -annual reports of difficulties to either go ¼ mile or increase 10 stages without resting.
c. Mobility restriction: defined as 2 successive semi -annual reports of great difficulties or inability to go ¼ mile or increase 10 stages without resting.

primary result measurements

1. UCMGP
2. Mobility restriction
3. Mobility restriction

important knowledge

Plasma phyllochinone (vitamin k 1 ) was positive with triglycerides and the hot and vice versa with IL-6 and knee pain.

Incidentally, Plasma UCMGP was positive with triglycerides and IL-6. Regardless of this, UCMGP was associated with the estimated GFR. African -American participants were more likely to have a lower UCMGP.

When the analyzes of phyllochinone in plasma and mobility were limited to the subgroup of participants in which UCMGP was measured (n = 716), the connection between phyllochinone in plasma and restricted mobility was similar, but the connection with mobility disability was weakened.

In a cross-sectional analysis, participants with less than 0.5 NMOL/L phyllochinone in plasma had a 1.49 times higher probability for a restricted mobility (ODDS ratio [or]: 1.49; 95% confidence interval [CI]: 1.04-2.13, fully adjusted) and almost twice as often suffer from mobility restricted (or: 1.95;

According to data from the National Health and Nutrition Examination Survey (Nhanes) from 2011-2012, an average of 57 % of men and 37.5 % of women do not even take the minimum of vitamin K per day.

The probability for mobility restriction and disability does not differ significantly between those with 0.5–1.0 nmol/l phyllochinone and those with at least 1.0 nmol/l (OR: 1.19; 95 % KI: 0.87–1.63 for mobility restriction; OR: 1.65; 95 % KI: 0.97-2.81 for mobility limitation, both fully adjusted).

The likelihood of having mobility restriction or disability does not differ significantly between the UCMGP tertile. Compared to Tertil 1, the ORS for mobility restrictions were 1.16 for Tertil 2 (95 %-KI: 0.77–1.74) and 1.42 for Tertil 3 (95 %-KI: 0.93–2.17). The odds for exposure to mobility (also compared to Tertil 1) were 0.88 for Tertil 2 (95 %KI: 0.44–1.74) and 1.62 for Tertil 3 (95 %-KI: 0.84–3.13), all completely adjusted.

Practice implications

This study is one of two studies to date that have examined the vitamin K status and frailty in older adults. An earlier study from 2016 examined the connection between the non-phosphorylated and non-carboxylated isoform of MGP (DP-UCMGP), another marker for vitamin K status.

nutritional defects are known risk factors for chronic diseases, functional impairments and mortality. It is therefore important to understand how nutrients influence the outbreak and progression of diseases in order to inform public health policy, teach clinics how to identify and examine risk patients, and to develop treatments, tackle and reverse the potentially underlying nutritional defects.

In this study, the researchers found that older adults with phyllochinone in the plasma of less than 0.5 NMOL/L developed mobility restriction and disability rather than those with at least 1.0 NMOL/L. After adapting for knee pain, the risk of mobility restrictions does not differ significantly between the patients with phyllochinone in the plasma of less than 0.5 NMOL/L and those with at least 1.0 nmol/l.

Plasma-UCMGP was not associated with a recovery of mobility. Plasma-UCMGP, however, was connected to the exposure to mobility, so that those in the middle UCMGP-Terstil likely developed a restriction of mobility than those in the lowest tertil, but there was no difference in the exposed mobility restriction between those in the highest and in the lowest tertil.

There are several challenges in interpreting and clinical use of these results. First, the association does not mean causality. Mobility is a complex mechanical process under neurological, musculoskeletal and hormonal control. The reduction to a single nutrient can overlook more fundamental reasons why a patient has problems.

Secondly, the vitamin K status, measured by surrogate markers such as UCMGP, is not a simple estimate. An abnormal lipid profile can influence the results, as stated in the present study. While UCMGP decreases with the consumption of vitamin K, the production of MGP is not measured regardless of vitamin K. The researchers have not measured MGP or given a UCMGP-to-MGP ratio, which would have been more revealing.

The challenge with replacement markers is important for clinicians, as we often discuss, recommend or test replacement markers. The most common vitamin K-dependent surrogate marker, which has been tested clinically, is sub-carboxylated osteocalcin (UCOC).

This marker was conversely associated with osteoporosis; However, as the authors of the present study emphasize, we have no clinical definition for vitamin K deficiency based on replacement markers, since the relevance of different threshold values ​​for clinical endpoints has not been extensively examined. In addition, according to a review of Shea and Booth from 2016, which was published in the magazine, nutrients "In contrast to other nutrients, there is no single biomarker that is considered a gold standard for vitamin K status."

The present study is insufficient in that it did not measure UCMGP and Plasma vitamin K in a serial UCMGP and plasma vitamin, which would have resulted in a better estimate of the vitamin K status. The study participants also did not fill a questionnaire for the frequency of food to estimate their vitamin K intake from food.

As an essential nutrient, vitamin K (as a phyllochinone that was measured in this study) can only be absorbed through food or nutritional supplements. It is important that a concentration of less than 0.5 NMOL/L, according to the researchers, is associated with reduced mobility, a vitamin K intake through the food of less than half of the recommended adequate supply (AI). The AI ​​for vitamin K for adults is 90 micrograms for women and 120 micrograms for men.

How often does it happen that people do not consume the active ingredient for vitamin K? According to data from the National Health and Nutrition Examination Survey (Nhanes) from 2011-2012, an average of 57 % of men and 37.5 % of women do not even take the minimum of vitamin K per day.

Therefore, the vitamin K status, such as the status of other essential nutrients, should be assessed in the context of a person's entire nutritional pattern. Plants, especially green leafy vegetables, are the main source of dietary vitamin K (phyllochinone) in the United States.

In view of the spread of poor nutrition in the United States, the control of the nutritional status is important if attempts are made to correlate a clinical end point with a single nutrient. An estimated 56 % of adults in the United States do not consume the minimum need for magnesium. 5 15 % consume less than half of the recommended daily dose (RDA) for vitamin C, 10 % consume less than half of the RDA for vitamin E and 18 % consume less than half of the RDA for zinc> 6
Apart from the fact that the eating habits have not been corrected, the researchers did not evaluate or corrected any other potential nutritional deficiencies that are known to affect mobility, such as: B. Vitamin D. A vitamin D deficiency is associated with a loss of muscle mass. 7.8 The weakness, 9 and reduced function of the lower extremities. 10 Finally, they did not examine the patients for sarcopenia that can also impair mobility.

Since the biochemistry includes a network of interactions between biochemical metabolic pathways, control of the entire nutritional status is important.

Research on how nutrients can correlate with diseases is important in order to advance the influence of nutrition on health and medicine. In order for research in this area to have the greatest clinical influence, future studies should correct nutritional status, evaluate the nutritional status based on laboratory tests and control variables, of which we already know that they contribute to reduced mobility and impairment.