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  • 1. Beställ onlineKöp publikationen >>
    Samefors, Maria
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Rosenhälsan primary health care centre, Jönköping, Sweden.
    Aspects of Vitamin D Deficiency in Elderly People in Nursing Homes and in Patients with Type 2 Diabetes: with Emphasis on Mortality, Cardiovascular Morbidity and Mental Health2020Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    D-vitamin bildas i huden när vi utsätts för solljus och i mindre mängder så kan vi även få D-vitamin via mat såsom fet fisk och berikade mejeriprodukter. På våra breddgrader i Sverige så tillverkar inte huden D-vitamin under vinterhalvåret (mellan oktober och mars), vilket medför att nivåerna av D-vitamin i kroppen sjunker. Äldre personer på särskilt boende löper särskilt stor risk för D-vitaminbrist och alla äldre rekommenderas att ta ett dagligt tillskott med D-vitamin. Tidigare studier har visat ett samband mellan låga D-vitaminnivåer och en rad olika sjukdomar, men det finns fortfarande kunskapsluckor bl. a. gällande äldre personer som bor på särskilt boende och patienter med typ 2-diabetes.

    Syftet med denna avhandling var att studera olika aspekter på D-vitaminbrist hos dessa två grupper och att undersöka om D-vitaminnivåerna var kopplade till risken för död, hjärtkärlsjukdom och nedsatt mental hälsa. Vi ville också undersöka om man genom att aktivt uppmuntra äldre personer på särskilt boende att vara utomhus sommartid kunde öka deras D-vitaminnivåer.

    I SHADES-studien (delarbete 1) visades att det fanns ett samband mellan D-vitaminbrist och en ökad risk för tidigare död hos äldre (>65 år) på särskilt boende i södra Sverige (Eslöv, Jönköping och Linköping). Risken att dö var dubbelt så stor hos de två fjärdedelar av studiedeltagarna som hade lägst och näst lägst D-vitaminvärden jämfört med den fjärdedel som hade högst värden. D-vitaminbrist var mycket vanligt, då 80% av studiedeltagarna hade för lågt D-vitaminvärde.

    I CARDIPP-studien visades att det fanns ett samband mellan låga D-vitaminnivåer och risken för hjärtkärlsjukdom (hjärtinfarkt och stroke) och död pga hjärtkärlsjukdom hos medelålders (55-66 år) patienter med typ 2- diabetes (delarbete 2).

    I CARDIPP-studien sågs även ett samband mellan låga D-vitaminnivåer och nedsatt mental hälsa utifrån svar på en enkät som heter SF-36 (delarbete 3). Patienterna fick svara på samma enkät 4 år senare, men det sågs inget samband mellan D-vitaminvärdet när de gick in i studien och den mentala hälsan vid uppföljningen. Ett annat område som enkäten undersökte var vitalitet, men något tydligt samband mellan D-vitaminnivåerna och patienternas vitalitet kunde inte visas.

    I studien Solljus och D-vitamin hos äldre på särskilt boende (delarbete 4) visades att den grupp av de äldre på särskilt boende som blev aktivt uppmuntrade till att vara utomhus 20-30 minuter mitt på dagen varje dag under 2 månader sommaren 2018 fick ökade D-vitaminnivåer och bättre mental hälsa enligt enkäten SF-36, medan vi inte såg lika tydlig skillnad i D-vitaminnivå eller mental hälsa hos den grupp som inte fick denna uppmuntran.

    Sammanfattningsvis så fann vi ett samband mellan låga D-vitaminnivåer och ökad risk för tidigare död hos äldre på särskilt boende samt mellan låga D-vitaminnivåer och hjärtkärlsjukdom och nedsatt mental hälsa hos patienter med typ 2-diabetes. Detta behöver dock inte betyda att det är de låga D-vitaminnivåerna som är den bakomliggande orsaken, men dessa studier antyder att D-vitaminvärdet ändå kan ge information om prognosen. Eftersom aktivt uppmuntrande till att spendera tid utomhus på sommaren ledde till ökade D-vitaminnivåer och förbättrad mental hälsa hos äldre på särskilt boende, så kan man överväga detta som ett komplement till D-vitamintabletter hos de äldre på sommaren.

    Delarbeten
    1. Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality
    Öppna denna publikation i ny flik eller fönster >>Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality
    Visa övriga...
    2014 (Engelska)Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 170, nr 5, s. 667-675Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE:

    Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality.

    DESIGN:

    The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden.

    METHODS:

    We analysed the levels of 25-hydroxyvitamin D₃ (25(OH)D₃) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D₃ quartiles were calculated.

    RESULTS:

    We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D₃ >48  nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D₃ <29  nmol/l) (P<0.05); 2.03 (1.32-3.14) in Q2 (25(OH)D₃ 30-37  nmol/l) (P<0.05) and 1.6 (1.03-2.48) in Q3 (25(OH)D₃ 38-47  nmol/l) (P<0.05). The mean 25(OH)D₃ concentration was 40.2  nmol/l (S.D. 16.0) and 80% had 25(OH)D₃ below 50  nmol/l. The vitamin D levels decreased from baseline to the second and third measurements.

    CONCLUSIONS:

    Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.

    Ort, förlag, år, upplaga, sidor
    Bioscientifica, 2014
    Nationell ämneskategori
    Gerontologi, medicinsk/hälsovetenskaplig inriktning
    Identifikatorer
    urn:nbn:se:liu:diva-108174 (URN)10.1530/EJE-13-0855 (DOI)000336728100008 ()24520134 (PubMedID)
    Tillgänglig från: 2014-06-26 Skapad: 2014-06-26 Senast uppdaterad: 2021-10-04Bibliografiskt granskad
    2. Association between serum 25(OH)D-3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study
    Öppna denna publikation i ny flik eller fönster >>Association between serum 25(OH)D-3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study
    Visa övriga...
    2017 (Engelska)Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, nr 3, s. 372-379Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group. Methods A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes -A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D-3 [25(OH)D-3] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D-3. Results We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D-3 was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D-3 amp;gt; 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D-3 amp;lt; 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D-3 35.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D-3 47.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027). Conclusions Low 25(OH)D-3 is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.

    Ort, förlag, år, upplaga, sidor
    WILEY, 2017
    Nationell ämneskategori
    Kardiologi
    Identifikatorer
    urn:nbn:se:liu:diva-136630 (URN)10.1111/dme.13290 (DOI)000397404200009 ()27862247 (PubMedID)
    Anmärkning

    Funding Agencies|Medical Research Council of Southeast Sweden; Futurum; King Gustaf V and Queen Victoria Freemason Foundation; Department of Medical and Health Sciences at Linkoping University; County Council of Ostergotland; Swedish Society of Medicine; National Research School in General Practice

    Tillgänglig från: 2017-04-21 Skapad: 2017-04-21 Senast uppdaterad: 2021-10-04
    3. Is there an association between serum 25(OH)D-3 and mental well-being in patients with type 2 diabetes? Results from a cohort study in primary care
    Öppna denna publikation i ny flik eller fönster >>Is there an association between serum 25(OH)D-3 and mental well-being in patients with type 2 diabetes? Results from a cohort study in primary care
    2020 (Engelska)Ingår i: HORMONES-INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM, ISSN 1109-3099, Vol. 19, s. 361-367Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose There are limited and inconsistent results on the correlation between vitamin D and mental health in patients with type 2 diabetes (T2D). Thus, our aim was to explore the association between vitamin D and mental well-being in a community-based sample of participants with T2D. Methods We analyzed serum 25-hydroxyvitamin D-3 (25(OH)D-3) in 698 patients with T2D at the baseline examination. The cohort was reinvestigated after 4 years. Data from SF-36 questionnaires measuring vitality and mental health at baseline and after 4 years were used for analyses. Results Serum 25(OH)D-3 was inversely associated with poor mental health at baseline (odds ratio (OR) for 10 nmol/l increase in 25(OH)D-3, 0.90 (95% confidence interval (CI) 0.83-0.96, p = 0.003)) but not at follow-up (p &gt; 0.05). Serum 25(OH)D-3 was not associated with vitality at baseline (p &gt; 0.05). At follow-up, there was an inverse association between 25(OH)D-3 and low vitality (OR for 10 nmol/l increase in 25(OH)D-3, 0.89 (95% CI 0.82-0.97, p = 0.009)) but not after adjustment. Conclusion We found an inverse association between 25(OH)D-3 and mental health in patients with T2D at baseline. We found no association between 25(OH)D-3 and vitality after adjustment. Future studies are needed to determine the association between vitamin D and mental well-being in patients with T2D.

    Ort, förlag, år, upplaga, sidor
    SPRINGER INTERNATIONAL PUBLISHING AG, 2020
    Nyckelord
    Vitamin D; Type 2 diabetes; Mental health; Vitality
    Nationell ämneskategori
    Endokrinologi och diabetes
    Identifikatorer
    urn:nbn:se:liu:diva-166162 (URN)10.1007/s42000-020-00190-1 (DOI)000534696000001 ()32440752 (PubMedID)
    Anmärkning

    Funding Agencies|Medical Research Council of Southeast Sweden; King Gustaf V and Queen Victoria Freemason Foundation; Department of Medical and Health Sciences at Linkoping University; County Council of Ostergotland; Swedish Society of Medicine; National Research School in General Practice; Futurum

    Tillgänglig från: 2020-06-09 Skapad: 2020-06-09 Senast uppdaterad: 2021-10-04
    4. Sunlight Exposure and Vitamin D Levels in Older People-An Intervention Study in Swedish Nursing Homes
    Öppna denna publikation i ny flik eller fönster >>Sunlight Exposure and Vitamin D Levels in Older People-An Intervention Study in Swedish Nursing Homes
    2020 (Engelska)Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 24, s. 1047-1052Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives Older people are recommended to take oral vitamin D supplements, but the main source of vitamin D is sunlight. Our aim was to explore whether active encouragement to spend time outdoors could increase the levels of serum 25-hydroxyvitamin D (25(OH)D) and increase the mental well-being of nursing home residents. Design A cluster randomized intervention trial. Setting Nursing homes in southern Sweden. Participants In total 40 people &gt;65 years. Intervention The intervention group was encouraged to go outside for 20-30 minutes between 11 a.m. and 3 p.m. every day for two months during the summer of 2018. Measurements We analyzed serum 25(OH)D before and after the summer. Data from SF-36 questionnaires measuring vitality and mental health were used for the analyses. Results In the intervention group, the baseline median (interquartile range (IQR)) of serum 25(OH)D was 42.5 (23.0) nmol/l and in the control group it was 52.0 (36.0) nmol/l. In the intervention group, the 25(OH)D levels increased significantly during the summer (p=0.011). In the control group, there was no significant change. The intervention group reported better self-perceived mental health after the summer compared to before the summer (p=0.015). In the control group, there was no difference in mental health. Conclusion Active encouragement to spend time outdoors during summertime improved the levels of serum 25(OH)D and self-perceived mental health significantly in older people in nursing homes and could complement or replace oral vitamin D supplementation in the summer.

    Ort, förlag, år, upplaga, sidor
    SPRINGER FRANCE, 2020
    Nyckelord
    Older people; nursing homes; vitamin D; mental health; intervention study
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-168546 (URN)10.1007/s12603-020-1435-z (DOI)000547217400002 ()
    Anmärkning

    Funding Agencies|Futurum, Jonkoping County Region

    Tillgänglig från: 2020-08-28 Skapad: 2020-08-28 Senast uppdaterad: 2021-10-04
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  • 2.
    Samefors, Maria
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Scragg, Robert
    Univ Auckland, New Zealand.
    Nyström, Fredrik H
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög.
    Is there an association between serum 25(OH)D-3 and mental well-being in patients with type 2 diabetes? Results from a cohort study in primary care2020Ingår i: HORMONES-INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM, ISSN 1109-3099, Vol. 19, s. 361-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose There are limited and inconsistent results on the correlation between vitamin D and mental health in patients with type 2 diabetes (T2D). Thus, our aim was to explore the association between vitamin D and mental well-being in a community-based sample of participants with T2D. Methods We analyzed serum 25-hydroxyvitamin D-3 (25(OH)D-3) in 698 patients with T2D at the baseline examination. The cohort was reinvestigated after 4 years. Data from SF-36 questionnaires measuring vitality and mental health at baseline and after 4 years were used for analyses. Results Serum 25(OH)D-3 was inversely associated with poor mental health at baseline (odds ratio (OR) for 10 nmol/l increase in 25(OH)D-3, 0.90 (95% confidence interval (CI) 0.83-0.96, p = 0.003)) but not at follow-up (p &gt; 0.05). Serum 25(OH)D-3 was not associated with vitality at baseline (p &gt; 0.05). At follow-up, there was an inverse association between 25(OH)D-3 and low vitality (OR for 10 nmol/l increase in 25(OH)D-3, 0.89 (95% CI 0.82-0.97, p = 0.009)) but not after adjustment. Conclusion We found an inverse association between 25(OH)D-3 and mental health in patients with T2D at baseline. We found no association between 25(OH)D-3 and vitality after adjustment. Future studies are needed to determine the association between vitamin D and mental well-being in patients with T2D.

    Ladda ner fulltext (pdf)
    fulltext
  • 3.
    Samefors, Maria
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Tengblad, A.
    Wetterhalsan, Sweden.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög.
    Sunlight Exposure and Vitamin D Levels in Older People-An Intervention Study in Swedish Nursing Homes2020Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 24, s. 1047-1052Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Older people are recommended to take oral vitamin D supplements, but the main source of vitamin D is sunlight. Our aim was to explore whether active encouragement to spend time outdoors could increase the levels of serum 25-hydroxyvitamin D (25(OH)D) and increase the mental well-being of nursing home residents. Design A cluster randomized intervention trial. Setting Nursing homes in southern Sweden. Participants In total 40 people &gt;65 years. Intervention The intervention group was encouraged to go outside for 20-30 minutes between 11 a.m. and 3 p.m. every day for two months during the summer of 2018. Measurements We analyzed serum 25(OH)D before and after the summer. Data from SF-36 questionnaires measuring vitality and mental health were used for the analyses. Results In the intervention group, the baseline median (interquartile range (IQR)) of serum 25(OH)D was 42.5 (23.0) nmol/l and in the control group it was 52.0 (36.0) nmol/l. In the intervention group, the 25(OH)D levels increased significantly during the summer (p=0.011). In the control group, there was no significant change. The intervention group reported better self-perceived mental health after the summer compared to before the summer (p=0.015). In the control group, there was no difference in mental health. Conclusion Active encouragement to spend time outdoors during summertime improved the levels of serum 25(OH)D and self-perceived mental health significantly in older people in nursing homes and could complement or replace oral vitamin D supplementation in the summer.

    Ladda ner fulltext (pdf)
    fulltext
  • 4.
    Samefors, Maria
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Scragg, R.
    University of Auckland, New Zealand.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Nyström, Fredrik H
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Endokrinmedicinska kliniken.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög.
    Association between serum 25(OH)D-3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study2017Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, nr 3, s. 372-379Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group. Methods A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes -A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D-3 [25(OH)D-3] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D-3. Results We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D-3 was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D-3 amp;gt; 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D-3 amp;lt; 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D-3 35.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D-3 47.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027). Conclusions Low 25(OH)D-3 is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.

  • 5.
    Samefors, Maria
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Mölstad, Sigvard
    Lund University, Malmö, Sweden.
    Lannering, Christina
    Futurum, Jönköping, Sweden.
    Midlöv, Patrik
    Lund University, Malmö, Sweden.
    Tengblad, Anders
    Futurum, Jönköping, Sweden.
    Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality2014Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 170, nr 5, s. 667-675Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality.

    DESIGN:

    The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden.

    METHODS:

    We analysed the levels of 25-hydroxyvitamin D₃ (25(OH)D₃) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D₃ quartiles were calculated.

    RESULTS:

    We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D₃ >48  nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D₃ <29  nmol/l) (P<0.05); 2.03 (1.32-3.14) in Q2 (25(OH)D₃ 30-37  nmol/l) (P<0.05) and 1.6 (1.03-2.48) in Q3 (25(OH)D₃ 38-47  nmol/l) (P<0.05). The mean 25(OH)D₃ concentration was 40.2  nmol/l (S.D. 16.0) and 80% had 25(OH)D₃ below 50  nmol/l. The vitamin D levels decreased from baseline to the second and third measurements.

    CONCLUSIONS:

    Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials.

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