Vitamin D deficiency and its potential associations on the health status of older patients with chronic obstructive pulmonary disease in rural Crete, Greece: A cross-sectional study.

Clinical nutrition ESPEN [Clin Nutr ESPEN] 2025 Jun; Vol. 67, pp. 665-672. Date of Electronic Publication: 2025 Apr 24.

Competing Interests: Declaration of competing interest The authors declare no conflicts of interest.
Background & Aims: While low vitamin D levels are common in Chronic Obstructive Pulmonary Disease (COPD) and have been associated with various adverse COPD-related outcomes, data on vitamin D status in rural COPD cohorts is limited. Therefore, the present study aimed to assess the prevalence of Vitamin D deficiency among patients with COPD living in rural areas and explore its potential association on the overall health status.
Methods: This cross-sectional study included 138 participants >40 years with COPD from the prospective "COlaborative care vs usual CARE in primary care patients with COPD" (COCARE) study. Sociodemographic characteristics, medical history, patient's health-related quality of life (HRQoL) with the COPD Assessment Test (CAT), fatigue with the Fatigue Severity Scale (FSS), phycological parameters with Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7), sleep disorders with the COPD and Asthma Sleep Impact Scale (CASIS), Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were collected. Vitamin D deficiency was defined as levels of 25-hydroxy (OH)-Vitamin D below 20 ng/mL. Multiple logistic regression analysis was conducted to test for associations of Vitamin D deficiency with CAT, FSS, PHQ-9, GAD-7, CASIS, AIS, and ESS, adjusting for age, gender, smoking status, comorbidities, and seasonality.
Results: Most of the participants were male (70 %) with a mean age of 68 ± 9 years and a mean Body Mass Index (BMI) of 30 ± 6 kg/m ² . Moreover, 33 % of the participants had Vitamin D deficiency. Vitamin D deficiency increased the odds for worse HRQoL (CAT≥10 OR: 2.3, CI: 0.9-6.4, p = 0.008), greater fatigue severity (FSS, OR: 1.2, CI: 0.4-3.1, p = 0.756), more depressive (PHQ-9≥5, OR: 2.9, CI: 1.1-7.4, p = 0.024), anxiety (GAD-7, OR: 0.8, CI: 0.3-2.1, p = 0.592) and insomnia symptoms (AIS score OR: 1.1, CI: 0.7-5, p = 0.29), excessive daytime sleepiness (ESS, OR: 1.1, CI: 0.7-5, p = 0.29), and lower sleep quality (CASIS OR: 2.5, CI: 0.9-6.5, p = 0.006).
Conclusion: In conclusion, our findings indicate that Vitamin D deficiency is positively associated with numerous negative health outcomes of patients with COPD, including worse HRQoL, fatigue, depression, anxiety and sleep disorders. However, further research is needed to determine the role of Vitamin D in the health status of these patients.
(Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

English

Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101654592 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2405-4577 (Electronic) Linking ISSN: 24054577 NLM ISO Abbreviation: Clin Nutr ESPEN Subsets: MEDLINE

Vitamin D Deficiency*/epidemiology , Vitamin D Deficiency*/complications , Vitamin D Deficiency*/blood , Pulmonary Disease, Chronic Obstructive*/epidemiology , Pulmonary Disease, Chronic Obstructive*/complications , Health Status*, Humans ; Cross-Sectional Studies ; Male ; Female ; Greece/epidemiology ; Aged ; Middle Aged ; Quality of Life ; Vitamin D/blood ; Vitamin D/analogs & derivatives ; Prevalence ; Rural Population ; Fatigue/epidemiology ; Prospective Studies ; Surveys and Questionnaires ; Aged, 80 and over

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