Abstract
Frailty is common in older hospitalised patients and may be associated with micronutrient malnutrition. Only limited studies have explored the relationship between frailty and vitamin C deficiency. This study investigated the prevalence of vitamin C deficiency and its association with frailty severity in patients ≥75 years admitted under a geriatric unit. Patients (n = 160) with a mean age of 84.4 ± 6.4 years were recruited and underwent frailty assessment by use of the Edmonton Frail Scale (EFS). Patients with an EFS score <10 were classified as non-frail/vulnerable/mildly frail and those with ≥10 as moderate–severely frail. Patients with vitamin C levels between 11–28 μmol/L were classified as vitamin C depleted while those with levels <11 μmol/L were classified as vitamin C deficient. A multivariate logistic regression model determined the relationship between vitamin C deficiency and frailty severity after adjustment for various co-variates. Fifty-seven (35.6%) patients were vitamin C depleted, while 42 (26.3%) had vitamin C deficiency. Vitamin C levels were significantly lower among patients who were moderate–severely frail when compared to those who were non-frail/vulnerable/mildly frail (p < 0.05). After adjusted analysis, vitamin C deficiency was 4.3-fold more likely to be associated with moderate–severe frailty (aOR 4.30, 95% CI 1.33-13.86, p = 0.015). Vitamin C deficiency is common and is associated with a greater severity of frailty in older hospitalised patients.
Highlights
Worldwide, with an aging population, there is a global interest in aging processes and age-related diseases
Six hundred and three patients were admitted under the geriatric evaluation and management (GEM) unit between May and December 2020, of whom, 176 patients were approached by convenience sampling for participation, and 160 patients were recruited for this study while 16 patients were excluded because of various reasons (Figure 1)
Sixty-eight (42.5%) patients were classified as non-frail/vulnerable or with mild frailty (EFS < 10) and 92 (57.5%) were classified with moderate to severely frailty (EFS ≥ 10)
Summary
With an aging population, there is a global interest in aging processes and age-related diseases. Frailty is associated with poor clinical outcomes such as falls, poor health related quality of life (HRQoL), nursing home placement and death [1,2]. This syndrome has been shown to be potentially preventable and can be reversed if targeted in earlier stages [3]. Micronutrient deficiencies can potentially increase the risk of frailty through multiple mechanisms such as an increase in oxidative stress and inflammation, the impairment of bone and muscle metabolism and a reduction in immunity [7]. Vitamin C is a powerful antioxidant and 40% of the total body pool is present in the skeletal muscles [8]
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