Vitamin D and omega-3 supplements fail to prevent frailty in geriatric patients: JAMA

A new study found that the rate of frailty change was unaffected by treatment with vitamin D3, or omega-3 fatty acid supplementation compared with placebo. The study was published in the journal JAMA Network Open. 

With the increasing trend in the geriatric population, there arose an increased gravity to identify the potential preventive strategies for frailty. Frailty is an age-dependent syndrome of reduced physiologic reserve in the face of external stressors that are associated with an increased risk of morbidity and mortality. Preventive strategies for frailty are necessary especially with supplements having anti-inflammatory properties like vitamin D3 or marine omega-3 fatty acids.

Evidence shows that omega-3 fatty acids can help in lowering the risk of frailty. Therefore, researchers conducted a study in 2021 to assess the effects of vitamin D3 and omega-3 supplements on change in frailty in older individuals. 

This study was a prespecified ancillary to the Vitamin D3 and Omega-3 (VITAL) trial. A total of 25 871 individuals without cancer or cardiovascular disease and with data on frailty, were recruited across all 50 US states. Participants had men aged ≥50 years and women aged ≥55 years. The participants were randomized to Vitamin D3 at a dosage of 2000 IU/d, and marine omega-3 fatty acids at a dosage of 1 g/d. The main outcome of measurement was a change in frailty score from baseline to year 5 with an intention-to-treat protocol, which was assessed using repeated measures. Frailty was assessed with a validated 36-item frailty index using annual questionnaires which measure function, cognition, mood, and comorbidities. Cox proportional hazards regression models assessed incident frailty. In subgroup analysis, the physical phenotype was used as a sensitivity analysis as an alternative frailty definition. 

Key findings: 

• Of 25,871 VITAL trial participants randomized, 25 057 had sufficient data to calculate a frailty index.
• The baseline mean (SD) age was 67.2 (7.0) years, and 12 698 (50.7.%) were women.
• The mean (SD) frailty score was 0.109 (0.090), and 3174 individuals (12.7%) were frail.
• During a median 5-year follow-up, mean (SD) frailty scores increased to 0.121 (0.099).
• Neither vitamin D3 nor omega-3 fatty acid supplementation affected mean frailty scores over time or the rate of change in mean frailty score.
• Incident frailty remained similar over time. Results were unchanged using the frailty physical phenotype.

Take home points: 

This study shows that treatment with vitamin D3 or omega-3 fatty acid supplementation unaffected the rate of frailty change or incidence over time. The study is an ancillary study of the VITAL randomized clinical trial. 

The study results are unsupportive of the routine use of either vitamin D3 or omega-3 fatty acid supplementation in generally healthy community-dwelling older adults for preventing frailty. 

Further reading: 10.1001/jamanetworkopen.2022.31206

Orkaby AR, Dushkes R, Ward R, Djousse L, Buring JE, Lee IM, Cook NR, LeBoff MS, Okereke OI, Copeland T, Manson JE. Effect of Vitamin D3 and Omega-3 Fatty Acid Supplementation on Risk of Frailty: An Ancillary Study of a Randomized Clinical Trial. JAMA Netw Open. 2022 Sep 1;5(9):e2231206.