High skeletal muscle mass is associated with increased serum 25(OH)D levels in elderly

Main Article Content

Verawati Sudarma
Lukman Halim


Low vitamin D has been associated with various health problems. Aging influences body composition, especially body fat and fat-free mass. Anthropometric measurements, such as body weight (BW), body mass index (BMI), body fat (BF), skeletal muscle mass (SMM), waist circumference (WC) and the waist-height ratio (WHtR) represent body composition which many studies proposed will influence serum vitamin D [25(OH)D]. The objective of the present study was to determine which anthropometric measurements were determinants of 25(OH)D levels in elderly.

A cross-sectional study was conducted involving 126 elderly (>60 years old) men and women at Pusat Santunan Dalam Keluarga (PUSAKA) Central Jakarta centers. Anthropometric measurements [body mass index (BMI), skeletal muscle mass (SMM), body fat (BF), and waist circumference (WC)] were determined by bioelectrical impedance analysis using the Omron body composition monitor with scales (HBF-375, Omron, Japan). Fasting blood samples were taken to measure 25(OH)D level by electrochemiluminescence immunoassay. Multivariate linear regression was used to analyze the data.

The data showed that BMI, BF, and WC were higher than recommended, while SMM and serum 25(OH)D were lower. When the analysis was done based on sex, there were significant differences in BF, SMM, WHtR, and serum 25(OH)D. In the linear regression multivariate analysis of log 25(OH)D with age and body anthropometric measurements, only SMM reached significance level (β=0.019; p=0.025).

This study demonstrated a positive association between skeletal muscle mass and serum levels of vitamin D in elderly.

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How to Cite
Sudarma, V., & Halim, L. (2017). High skeletal muscle mass is associated with increased serum 25(OH)D levels in elderly. Universa Medicina, 36(3), 236–242. https://doi.org/10.18051/UnivMed.2017.v36.236-242
Original Articles


Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81.

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96:1911-30.

Batsis JA, Mackenzie TA, Bartels SJ, et al. Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999-2004. Int J Obes 2016;40:761-7.

Kull M, Kallikorm R, Lember M. Body mass index determines sunbathing habits: implications on vitamin D levels. Intern Med J 2009;39:256-8.

Han SS, Kim M, Lee SMM, et al. Association between body fat and vitamin D status in Korean adults. Asia Pac J Clin Nutr 2014;23:65-75.

Saneei P, Salehi-Abargouei A, Esmaillzadeh A. Serum 25-hydroxyvitamin D levels in relation to body mass index: a systemic review and meta-analysis. Obes Rev 2013;14:393-404.

Pereira-Santos M, Costa PRF, Assis AMO, et al. Obesity and vitamin D deficiency: a systemic review and meta-analysis. Obes Rev 2015;16:341-9.

Marantes I, Achenbach SJ, Atkinson EJ, et al. Is vitamin D a determinant of muscle mass and strength? JBMR 2011;26:2860-71.

Visser M, Deeg DJH, Lips P. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 2008;88:5766-72.

Kuwabara A, Tsugawa N, Kondo H, et al. Associations between serum 25-hydroxyvitamin D3 level and skeletal muscle mass and lower limb muscle strength in Japanese middle-aged subjects. Osteoporosis Sarcopenia 2017;3:53-8.

Palomer X, González-Clemente JM, Blanco-Vaca F, et al. Role of vitamin D in the pathogenesis of type 2 diabetes mellitus. Diab Obes Metabol 2008:10:185–97.

Wimalawansa SJ. Vitamin D in the new millennium. Curr Osteoporosis Rep 2012;10:4–15.

Sari DK, Al Rasyid H, Lipoeto NI, et al. Are avoiding sunlight exposure and low physical activity resulting micro evolution in tropical country women? SCIRJ 2013;1:18-26.

Sánchez-García S, García-Peña C, Duque-López MX, et al. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health 2007;7:2. DOI:10.1186/1471-2458-7-2

WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.

Sari K, Mansyur M. Female, live in urban, and the existence of a caregiver increased risk over-nutrition in elderly: an Indonesian national study 2010. Health Sci Indones 2012;3:9e14.

Schneider HJ, Friedrich N, Klotsche J, Pieper L, et al. The predictive value of different measures of obesity for incident cardiovascular events and mortality. J Clin Endocrinol Metab 2010;95:1777–85.

Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 2008;61:646–53.

Browning LM, Hsieh SD, Ashwell A. Systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev 2010;23:247–69.

Handono K, Ranuwijaya LK, Fitri LE, et al. The correlation between serum concentration of vitamin D with vitamin D receptor expression and disease activity in Indonesian patients with systemic lupus erythematosus: a preliminary study. Trop Life Sci Res 2014;4:113-8.

Hidayat R, Setiati S, Soewondo P. The association between vitamin D deficiency and type 2 diabetes mellitus in elderly patients. Acta Med Indones 2010;42:123-9.

Angel B, Sanchez H, Lera L, et al. Vitamin D deficiency/insufficiency and obesity and metabolic disorders in community-living Chilean elderly people. JARCP 2013;2:251-6.

Huang C, Huang YA, Lai Y, et al. Prevalence and predictors of hypovitaminosis D among the elderly in subtropical region. PLoS ONE 12: e0181063. https://doi.org/10.1371/journal.pone.0181063.

Lim JS, Kim KM, Rhee Y, et al. Gender-dependent skeletal muscle effects of vitamin D deficiency in a younger generation. J Clin Endocrinol Metab 2012;97:1995-2004. doi: 10.1210/jc.2011-3098.

Ko MJ, Yun S, Oh K, et al. Relation of serum 25-hydroxyvitamin D status with skeletal muscle mass by sex and age group among Korean adults. Br J Nutr 2015;114:1838-44.

Setiati S, Oemardi M, Sutrisna B. The role of ultraviolet B from sun exposure on vitamin D and parathyroid hormone level in elderly women in Indonesia. Asian J Gerontol Geriatr 2007;2:126-32.

Meng L, Man Q, Yuan L, et al. Serum 25-hydroxyvitamin D and elderly skeletal muscle mass and function in urban north China. Asia Pac J Clin Nutr 2017;26:849-55.

Batsis JA, Sahakyan KR, Rodriguez-Escudero JP, et al. Normal weight obesity and mortality in United States subjects 60 years of age (from the Third National Health and Nutrition Examination Survey). Am J Cardiol 2013;112:1592–8.

Batsis JA, Singh S, Lopez-Jimenez F. Anthropometric measurements and survival in older Americans: results from the third National Health and Nutrition Examination Survey. J Nutr Health Aging 2014;18:123–30.

English KL, Paddon-Jones D. Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care 2010;13:34-9.