News — June 2009

New Recommendations Issued for Inpatient Glycemic Control
New recommendations released by a consensus group of the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) are calling for major changes in the way health care professionals treat hospitalized patients with high blood glucose levels. According to a news release, the authors recommend revised glucose targets of 140 to 180 mg/dL in the ICU setting and between 100 to 180 mg/dL for most patients admitted to general medical-surgical wards.

The recommendations, published online and appearing in Endocrine Practice and Diabetes Care, come at a time when attempts to intensively manage glucose targets in the ICU setting have shown inconsistent results in outcomes for patients, according to the authors. Several recent randomized controlled clinical trials in critically ill patients in ICUs with diabetes or elevated blood glucose levels have failed to show a significant improvement in mortality with intensive insulin therapy to achieve near normal glucose levels. Additionally, a large newly published randomized controlled trial showed an increase in mortality risk associated with intensive control of glycemia targeting blood glucose of 80 to 110 mg/dL. These outcomes have raised concerns regarding specific glycemic targets and the means for achieving them in both critically and non-critically ill patients.

Recognizing the importance of glycemic control across the continuum of care, experts from AACE and ADA were invited to develop an updated consensus statement on inpatient glycemic management.

After a thorough analysis of all the published trials, the authors believe that patients with elevations in blood glucose should continue to be carefully treated but to less intensive blood glucose targets than were previously suggested, according to the statement. The authors recommend revised glucose targets of 140 to 180 mg/dL for critically ill patients in ICU settings.

"We are witnessing an evolution in the management of hyperglycemia in inpatient settings," said Etie S. Moghissi, MD, AACE Chair of the Inpatient Glycemic Control Consensus Panel. "Despite some inconsistencies in the clinical trial results, it would be a serious error to conclude that judicious control of glycemia in hospitalized patients is not warranted."

The complexity of inpatient glycemic management necessitates a system approach that facilitates safe practices that reduce the risk for errors and episodes of severe hypoglycemia. The consensus group recommends a multidisciplinary approach for care from admission to discharge from the hospital.

"The responsibility for management of hyperglycemia shifts from the health care team to the patient following hospital discharge," said Mary Korytkowski, MD, ADA Chair of the Inpatient Glycemic Control Consensus Panel. "It is therefore important that patients receive the information necessary to safely manage this aspect of their care once they are at home."

For more news from AACE's 18th Annual Meeting & Clinical Congress in Houston, please see page 53.

Hypoglycemia Poses Serious Health Threat for Patients With CKD
Hypoglycemia poses a serious health threat for patients with chronic kidney disease (CKD), according to a study released online and in the Clinical Journal of the American Society of Nephrology (ASN).

The findings indicate that hypoglycemia may account for some portion of the excess heart-related deaths seen in patients with CKD, stated a news release from the ASN. Jeffrey C. Fink, MD, University of Maryland Medical System, and Maureen F. Moen, MD, University of Maryland School of Medicine, Baltimore, and colleagues designed a study to examine the incidence of hypoglycemia among patients with CKD and to determine whether the condition might contribute to patients' deaths.

The researchers assessed the incidence of hypoglycemia in patients with CKD relative to patients without CKD, both with and without diabetes, and they examined the association of hypoglycemia with subsequent near-term deaths (1 day after blood glucose measurement). Analysis included information from 243,222 individuals cared for at the Veterans Health Administration. The incidence of hypoglycemia was higher in patients with CKD versus without, both among patients with diabetes and among those without. The risk of hypoglycemia was highest in individuals with both CKD and diabetes, and hypoglycemia increased patients' risk of dying in the near term.

According to the authors, there was a reduced risk of near-term death in individuals with CKD relative to those without, and this attenuation in the risk of death might relate to an increased quality of care in CKD patients relative to diabetic patients without CKD. "The association of hypoglycemia with 1-day mortality underscores the significance of this metabolic disturbance in patients with diabetes and [CKD]," said Dr. Fink.

Although details on therapy were not included in this study, the findings are consistent with others that have shown that putting patients on intensive glucose-lowering medications can lead to an increased incidence of hypoglycemia and does not prolong their survival, the news release stated.

Researchers Uncover Genetic Variants Associated With BP
An international research team has identified a number of unsuspected genetic variants associated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension, suggesting potential avenues of investigation for the prevention or treatment of hypertension.

The analysis of over 29,000 participants was presented at the American Society of Hypertension (ASH) 24th Annual Scientific Meeting and Exposition, and is published in Nature Genetics. "This study provides important new insights into the biology of blood pressure regulation and, with continued research, may lead to the development of novel therapeutic approaches to combat hypertension and its complications," said Elizabeth G. Nabel, MD, of the National Heart, Lung, and Blood Institute (NHLBI), in a news release from the National Institutes of Health.

Blood pressure has a substantial genetic component, and hypertension runs in families. Previous attempts to identify genes associated with blood pressure, however, have met with limited success. In a genome-wide association study (GWAS), researchers scanned millions of common genetic variants of individuals from the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) consortium to find variants associated with blood pressure and hypertension. This extensive resource includes white men and women from the Framingham Heart Study, ARIC (Atherosclerosis Risk in Communities) study, Cardiovascular Health Study, the Rotterdam Study, the Rotterdam Extension Study, and the Age, Gene/Environment Susceptibility Reykjavik Study.

Investigators identified a number of single-nucleotide polymorphisms (SNPs) associated with SBP, DBP, and hypertension. When they jointly analyzed their findings with those from the GWAS of over 34,000 participants in the Global BPgen Consortium (whose results are presented in an accompanying article in the same issue of Nature Genetics), they identified 11 genes showing significant associations across the genome: four for SBP, six for DBP, and one for hypertension.

The blood pressure genes include ATP2B1, which encodes PMCA1, a cell membrane enzyme that is involved in calcium transport; CACNB2, which encodes part of a calcium channel protein; and CYP17A1, which encodes an enzyme that is necessary for steroid production.

One detected variant is within the gene SH2B3 and has been associated with autoimmune diseases, hinting that pathways involved with the immune response may influence blood pressure. Researchers found that the top 10 SNPs for SBP and DBP were each associated with around a 1 and 0.5 mm Hg increase in SBP and DBP, respectively. The prevalence of hypertension increased as the number of variants increased.

For more news from the ASH meeting, please see page 56.

FDA Approves Amlodipine, Olmesartan Medoxomil Combo for Hypertension
The US Food and Drug Administration (FDA) has approved the combination treatment of amlodipine plus olmesartan medoxomil (Azor, Daiichi Sankyo Co., Ltd.) as first-line therapy in patients likely to need multiple antihypertensive agents to achieve their blood pressure goals.

The FDA approval reinforces current US guidelines to prescribe combination drugs as initial therapy for patients likely to need more than one drug, according to a news release from the company.

"The approval of [amlodipine/olmesartan medoxomil] as a first-line therapy gives doctors an important treatment option that may help the many patients who require multiple medications avoid several treatment steps to achieve their blood pressure goals," said Keith C. Ferdinand, MD, Emory School of Medicine, Atlanta. "Fixed-dose combinations like [amlodipine/olmesartan medoxomil] provide patients with a more convenient option than separate monotherapies, which may help simplify the treatment regimen and decrease overall pill burden."

The approval was based on data from the registrational trial, which provided estimates of the probability of patients attaining blood pressure goals with amlodipine/olmesartan medoxomil compared with amlodipine or olmesartan medoxomil alone. The only adverse reaction that occurred in ≥3% of patients treated with amlodipine/olmesartan medoxomil and more frequently than placebo was edema. Adverse reactions seen at lower rates but at about the same or greater incidence as in patients receiving placebo included hypotension, orthostatic hypotension, rash, pruritus, palpitation, urinary frequency, and nocturia.

Lifestyle Plays a Role in Diabetes Risk Even Among Older Adults
Even for older adults, lifestyle factors such as physical activity, dietary habits, tobacco and alcohol use, and the amount of body fat are associated with risk of new-onset diabetes, according to a study published in the Archives of Internal Medicine.

"Given medical challenges, health care costs, long-term complications, and growing incidence and prevalence of type 2 diabetes, preventing the onset of clinical diabetes is of paramount importance," the authors wrote.

Although previous studies have found lifestyle factors such as those mentioned above to be risk factors linked to onset of diabetes in younger populations, the combined impact of these factors on the risk of diabetes in older adults is largely unknown, according to a news release from the American Medical Association, the journal's publisher.

Dariush Mozaffarian, MD, DrPH, from Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, and colleagues with the Cardiovascular Health Study examined the relationships of lifestyle risk factors with incidence of diabetes during a 10-year period (1989 to 1998) among 4,883 men and women aged ≥65 years.

Ihe study population included 58.6% women and 11.4% nonwhites; 95% of the nonwhite participants were black, and the average participant's age was 73 years at baseline. Approximately half of the participants had never smoked.

Low-risk-lifestyle groups were defined by physical activity level (leisure time activity and walking pace) above the median; dietary score (higher fiber intake, and polyunsaturated-to-saturated fat ratio, lower trans-fat intake and lower average glycemic index); amount of smoking, if any; alcohol use (predominantly light or moderate); body mass index <25 kg/m2; and waist circumference of ≤34.6 inches for women or ≤36 inches for men.

After adjustment for age, sex, race, education, annual income, and other lifestyle factors simultaneously, each lifestyle risk factor was independently associated with incidence of diabetes. Overall, each additional lifestyle factor an individual had in the lower-risk group was associated with a 35% lower risk of diabetes.

Individuals in the low-risk category for only physical activity level and dietary habits (nearly one in four adults) had a 46% lower incidence of diabetes. Combining low-risk groups for physical activity level, dietary habits, smoking habits, and alcohol use (6% of participants), an 82% lower risk of diabetes was present, and four in five new cases of diabetes appeared to be attributable to not having these low-risk lifestyle factors. Adding either not being overweight or not having large waist circumference was associated with an 89% lower risk of diabetes.

"These findings provide an estimate of the public health burden of combined nonoptimal lifestyle risk factors for incidence of diabetes in older adults, the fastest growing segment of the US population," the authors wrote. "Our findings suggest that, even later in life, the great majority of cases of diabetes are related to lifestyle factors."

Keeping Diabetes Under Control Still Difficult for Many Americans
Just more than half of the 18 million Americans diagnosed with diabetes had their blood glucose, cholesterol, and blood pressure under optimum control in 2006, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ).

The federal agency's analysis found that about 55% of American adults with diabetes had their glucose and total cholesterol levels under control, and about 59% had their blood pressure under control. Failure to properly manage diabetes can increase the risk of complications such as myocardial infarction (MI) and stroke.

Diabetes is the sixth leading cause of death in the United States, with $116 billion spent on medical care for people with the disease, according to AHRQ's recently released 2008 National Healthcare Disparities Report. The report also indicates that another 6 million Americans may have diabetes but don't know it.

In addition, the report shows that:

• In 2006, just 43% of blacks and 38% of Mexican Americans with diabetes had their glucose levels under control, compared with 61% of non-Hispanic whites with diabetes.
• From 2002 to 2006, the percentage of people with diabetes who had their blood pressure under control improved for blacks, from 39% to 58%, and for Mexican Americans, from 49% to 67%. By 2006, there were no significant differences in blood pressure control among blacks, Mexican Americans, and non-Hispanic whites with diabetes.

Pioglitazone Metformin Combination Approved for Type 2 Diabetes
The FDA has approved an extended-release version of the combination pioglitazone HCl and metformin HCl extended release, under the brand name Actoplus Met XR (Takeda Pharmaceuticals North America, Inc.). According to a company news release, the combination therapy is approved as an adjunct to diet and exercise for the treatment of type 2 diabetes.

This combination is the first and only prescription oral antidiabetic fixed-dose combination medication available with the extended-release form of metformin to help improve glycemic control in a once-daily dosing option, according to the company. The combination agent is indicated for adults with type 2 diabetes who are already treated with pioglitazone (Actos, Takeda) and metformin or who have inadequate glycemic control on pioglitazone or metformin alone.

Pioglitazone directly targets insulin resistance, and metformin acts by reducing the amount of glucose produced by the liver. These medications work in combination to help patients with type 2 diabetes manage their blood glucose levels.

AUA Counters Mainstream Recommendations With New Guidelines on PSA Testing

The American Urological Association (AUA) issued new clinical guidance—which directly contrasts recent recommendations issued by other major groups—about prostate cancer screening, asserting that the prostate-specific antigen (PSA) test should be offered to well-informed men aged ≥40 years who have a life expectancy of ≥10 years.

The PSA test, as well as how it is used to guide patient care (eg, at what age men should begin regular testing, intervals at which the test should be repeated, at what point a biopsy is necessary), is highly controversial; however, the AUA believes that, when offered and interpreted appropriately the PSA test may provide essential information for the diagnosis, pretreatment staging, or risk assessment, and posttreatment monitoring of prostate cancer.

According to a news release, the new Best Practice Statement updates the AUA's previous guidance, which was issued in 2000. Major changes to the AUA statement include new recommendations about who should be considered for PSA testing, as well as when a biopsy is indicated following an abnormal PSA reading.

The AUA stated that the future risk of prostate cancer is closely related to a man's PSA score; a baseline PSA level above the median for age 40 years is a strong predictor of prostate cancer.

Such testing may not only allow for earlier detection of more curable cancers but may also allow for more efficient, less frequent testing. Men who wish to be screened for prostate cancer should have both a PSA test and a digital rectal examination. The statement also noted that other factors such as family history, age, overall health, and ethnicity should be combined with the results of PSA testing and physical examination in order to better determine the risk of prostate cancer.

The statement recommends that the benefits and risks of prostate cancer screening be discussed with patients, including the risk of overdetection and detection of some cancers that may not need immediate treatment. The new statement is available online at www.AUAnet.org.

Increased Risk of Fractures, Death Following Prostate Cancer Therapy
Prostate cancer patients who undergo therapy to decrease testosterone levels increase their risk of developing bone- and heart-related side effects compared with patients who do not take these medications, according to the analysis. Published in Cancer, the study indicates that preventive measures and scrutiny of patients' health can keep men from experiencing these potentially serious consequences.

Medical treatments that decrease testosterone levels—androgen deprivation therapy (ADT)—are important and effective therapies for men with prostate cancer but they can cause a variety of side effects. These include skeletal and cardiovascular complications, sexual dysfunction, periodontal disease, and mood disorders, according to an American Cancer Society (ACS) news release.

Bone and heart complications are among the most serious side effects associated with ADT, but the actual risk patients have of developing these effects is unknown. Lockwood Taylor, MPH, of the University of Texas Health Science Center and colleagues conducted a study to assess this risk by analyzing all of the literature related to side effects from ADT published between 1996 and mid-2008.

The review revealed that men treated with ADT for prostate cancer had an increased risk of bone fractures and heart-related death, although the absolute risk for both was still low. For bone fractures, there was a 23% increased risk compared with prostate cancer patients who did not undergo the treatment. The absolute risk of fracture among ADT-exposed men was still only 7.2 per 100 person years, however. For heart-related death, the increased risk among ADT-exposed men was 17% higher compared with other prostate cancer patients. Because the baseline risk is low, the increase translated to an additional one-to-two deaths per 1,000 men who received ADT. Two large studies also documented significant increases in diabetes risk associated with the therapy, the ACS stated.

"While the absolute risks of fracture and cardiovascular mortality are low among men treated with ADT, preventive treatments may further reduce the risk of these serious adverse outcomes related to ADT," the authors wrote. They also noted that because some patients may benefit from this therapy more than others, physicians should consider each patient's overall health and prostate cancer status when weighing treatment options.

New Educational Tool to Facilitate Teaching, Understanding of FRAX
The International Osteoporosis Foundation (IOF) will soon launch the FRAX Slide-kit CD-Rom, an educational tool targeted at clinicians and health care professionals. The slide kit, developed by IOF in cooperation with Eugene McCloskey, MD, and Prof. John Kanis of the World Health Organization (WHO) Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK, will help understanding and teaching of the WHO Fracture Risk Assessment Tool (FRAX).

According to an IOF news release, FRAX is a simple Web-based tool that integrates clinical information in a quantitative manner to predict a 10-year probability of major osteoporotic fracture for both women and men in different countries. The FRAX calculation algorithm is derived from a series of meta-analyses using the primary data from population-based cohorts that have identified several clinical risk factors for fracture. This practical online tool, currently available for 12 countries, can be accessed at www.shef.ac.uk/FRAX/.

Intended for scientists and health care professionals who want to educate their peers on this new osteoporosis diagnosis paradigm, the FRAX Slide-kit contains the most relevant information and visual aids linked to the development of the FRAX tool, with commentaries highlighting key messages to be conveyed when speaking about fracture risk. The kit also includes an up-to-date list of references for further reading.

DHEA Hormone Replacement Increases Bone Density in Older Women
Taking a dehydroepiandrosterone (DHEA) supplement combined with vitamin D and calcium can significantly improve spinal bone density in older women, according to a new study from a Saint Louis University scientist and his colleagues at Washington University.

"The results of our study are very promising," said Edward Weiss, PhD, Associate Professor of Nutrition and Dietetics at Saint Louis University's Doisy College of Health Sciences and lead author of the study. "Similar studies have demonstrated much smaller benefits for bone than we found. Calcium and vitamin D deficiencies, however, which are present in half of older adults, may have prevented DHEA from improving bone density in the earlier studies. In our study, we supplemented all participants with calcium and vitamin D to ensure that deficiencies were not present. This may explain why our study showed more favorable effects on bone density."

DHEA—a naturally occurring steroid hormone produced in the adrenal gland, gonads, and brain—decreases with age. Dr. Weiss said that low DHEA concentration has been associated with low bone density, which led researchers to question whether restoring DHEA levels could improve or preserve bone health.

The 2-year study divided men and women, aged 65 to 75 years, into two groups. The first group received the DHEA supplement, vitamin D, and calcium for 2 years, and the control group received placebo, vitamin D, and calcium for the first year and then received the DHEA supplement the second year in place of placebo, a university news release stated.

The effects of the treatment differed for men compared with women. After the first year, women in the treatment group experienced an approximate 2% increase in bone density, while women in the control group did not see an increase. After the second year when both groups took the DHEA supplement, women in the treatment arm had an additional 2% increase for a total of approximately 4%, and women who switched from placebo to DHEA also experienced an approximate 2% increase.

The same treatment did not offer similar benefits for older men. Instead, men in both the test and control groups experienced a 1% to 2% increase in spinal bone density. According to researchers, the results suggest that vitamin D and calcium supplements, which were given to both groups, could be responsible for the increase in bone density.

The results of the study are promising for older women. According to Dr. Weiss, patients who achieve similar increases of 2% to 4% in spinal bone density with the help of medication experience a 30% to 50% reduction in risk of spine fractures.

Dr. Weiss said that patients should consult with their doctor before taking DHEA, available as an over-the-counter dietary supplement.

Decline in HRT Use May Have Led to Fewer MIs in Women
Now that the popularity of hormone replacement therapy (HRT) has declined, so too has the number of myocardial infarctions (MIs) in menopausal women each year, a new study has found. There has been no such difference in the rate of strokes, however.

According to a news release from Health Behavior News Service, the study, published in the the journal Medical Care, looked at whether the decreased use of HRT has affected the rate of cardiovascular health outcomes.

Before 2002, physicians believed HRT reduced the risk of coronary heart disease by up to 50% in menopausal women. As a result, physicians prescribed it broadly to treat many of the symptoms of menopause, as well as to protect women against cardiovascular disease (CVD). A report by the WHI (Women's Health Initiative) in 2002 revealed that HRT actually had the opposite effect—it increased the risk of MI in these women.

"After the 2002 report, the use of HRT in women aged 50 to 69 years declined from >30% to <15%," said lead study author Kanaka Shetty, MD.

Dr. Shetty, at the RAND Corporation in Santa Monica, and colleagues evaluated data from 1990 to 2005 for women aged 40 and 79 years. The researchers used US death records, hospital discharge data, and national surveys of medication usage.

They found that the decreased use of HRT did not reduce the number of hospitalizations or deaths from stroke. It was, however, linked to a decrease in acute MI among women. The study found that for every 10,000 additional HRT users in 1 year, there will be 25 more MIs. By comparison, the WHI found seven more MIs per 10,000 women on HRT in 1 year. As for the noneffect on stroke, "We were surprised that HRT had such divergent effects on stroke and acute MI in the overall population," Dr. Shetty said.

Nieca Goldberg, MD, suggested there might be other reasons for the decline in MIs. "The reduction in hormone therapy coincided with the American Heart Association's and NHLBI's women and heart disease awareness campaigns," said Dr. Goldberg, a cardiologist at Total Heart Care, New York, NY. "The lower rate of MIs may be due to better screening for heart disease risk factors in women, more women scheduling appointments to be screened for heart disease risk factors, and better awareness of women's MI symptoms by physicians."

Dr. Goldberg, whose practice focuses primarily on women, said, "It's premature to attribute the decline in MI rates to the decline in hormone therapy."

Ultrasound Can Help Low-Risk Patients Avoid Invasive Thyroid Biopsy
The prevalence of benign thyroid nodules is high, and there are certain ultrasound features suggesting malignancy that can help radiologists determine whether or not a biopsy is needed, according to a study performed at the University of California San Francisco Medical Center.

A total of 245 patients (54 patients with cancer, 191 patients without cancer) were analyzed, stated a news release from the American Roentgen Ray Society,

"Our study supports previous data showing that some sonographic features of thyroid nodules are suggestive of malignant nature and should lead to biopsy," said Dorra Sellami, MD, lead author of the study. "These features include microcalcifications (which increase the risk of cancer 16-fold), a shape taller than wide (increases the risk of cancer 3.7-fold), and hypoechogenicity (twofold increase in risk of cancer). Other features may suggest that a nodule is benign, such as hyperechogenicity (40% increase in risk of cancer)," she said. "Current clinical guidelines recommend biopsy of all lesions ≥10 mm, however, in our study of patients with no thyroid cancer, 49% had at least one nodule ≥10 mm," said Dr. Sellami.

"Very few thyroid nodules are obviously malignant or benign. Most thyroid nodules we see by ultrasound are indeterminate, and in order to rule out cancer, a fine-needle aspiration is often recommended. This results in a ratio of ten benign nodules sampled for one cancer diagnosed," she said.

"Our findings will help radiologists and clinicians determine which nodules are definitely not suspicious and can be watched. I think that our study is one step toward decreasing the number of invasive procedures in patients with benign thyroid nodules while maintaining the same vigilance in detecting thyroid cancer in its early stages," said Dr. Sellami in the news release.

For more information on thyroid nodules, see "Diagnosis and Management of Thyroid Nodules: An Overview," page 23 of the April 2009 issue of Review of Endocrinology.

Older People Need More Sun
Spending more time in the sunshine could help older people to reduce their risk of developing heart disease and diabetes. Exposure to sunlight stimulates vitamin D in the skin, and older people are more likely to have a vitamin D deficiency due to the natural aging process and changes in lifestyle.

Researchers at the University of Warwick, UK, have shown vitamin D deficiency is significantly associated with metabolic syndrome, a combination of medical and metabolic disorders that increase the risk of developing CVD and diabetes, according to a university news release.

The research team, led by Oscar Franco, MD, at Warwick Medical School, investigated the association between vitamin D levels in the blood and the prevalence of metabolic syndrome in 3,262 people aged 50 to 70 years in China.

His team found a high correlation between low vitamin D levels and the prevalence of metabolic syndrome. They found 94% of people in the study had a vitamin D (25-hydroxyvitamin D [25-OH-D]) deficiency or insufficiency. The results showed 42.3% of these people also had metabolic syndrome.

The results of the study, published in Diabetes Care, are consistent with the findings of other studies in Western populations, and Dr. Franco suggests vitamin D deficiency could become a global health problem.

"Vitamin D deficiency is becoming a condition that is causing a large burden of disease across the globe with particular deleterious impact among the elderly. Our results are consistent with those found in British and American populations. We found that low vitamin D levels were associated with an increased risk of having metabolic syndrome and was also significantly associated with increased insulin resistance," he said in the news release.

Many factors that could explain why older people had less vitamin D in their blood, including changes in lifestyle factors such as clothing and outdoor activity, he added.

"As we get older, our skin is less efficient at forming vitamin D, and our diet may also become less varied, with a lower natural vitamin D content. Most importantly, however, the dermal production of vitamin D following a standard exposure to UVB light decreases with age because of atrophic skin changes. When we are older, we may need to spend more time outdoors to stimulate the same levels of vitamin D we had when we were younger," Dr. Franco said.

Vitamin D deficiency exists when the concentration of 25-OH-D in the blood serum occurs at ≤12 ng/mL. The normal concentration of 25-OH-D 25 to 50 ng/mL.

This study was carried out in collaboration with colleagues from the Shanghai Institute of Biological Sciences in China. The team recruited 3,262 community residents aged 50 to 70 years from Beijing and Shanghai in China as part of the Nutrition and Health of Aging Population in China project.

"Vitamin D deficiency is now recognised as a worldwide concern, and metabolic syndrome has become a global epidemic. More research is needed to find out why older people are more likely to have lower levels of vitamin D and how this is linked to the development of metabolic syndrome and related metabolic diseases," Dr. Franco concluded.