Prevalence and Factors Associated with Vitamin D Inadequacy in the Elderly Population of South Sulawesi

Prevalence and Factors Associated with Vitamin D Inadequacy in the Elderly Population of South Sulawesi | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Factors Associated with Vitamin D Inadequacy in the Elderly Population of South Sulawesi Haniyyah Isman, Noto Dwimartutie, Siti Setiati, Pringgodigdo Nugroho This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7024040/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Vitamin D inadequacy remains a health issue in elderly population of Indonesia. Vitamin D has skeletal and non-skeletal effects, that can improve elderly quality of life. Various factors associated with inadequate vitamin D levels are observed in this study. Objective: To determine the prevalence and factors associated with vitamin D inadequacy in the elderly population of South Sulawesi. Methods: This was a cross-sectional study using multistage cluster random sampling conducted in Makassar City and East Luwu Regency, South Sulawesi Province, from December 2024 to May 2025. Sociodemographic data and risk factors were collected using questionnaire and Serum vitamin D levels were measured using the Chemiluminescent Microparticle Immunoassay (CMIA) method. Results: A total of 301 subjects met the inclusion and exclusion criteria, with median age 68 (64 – 73) years old and mainly female (62,79%).The prevalence of Vitamin D inadequacy is 53,5%. Multivariate test showed low sun exposure [PR: 2,226 95% CI (1,731 – 2,862)], sedentary physical activity [ PR: 1,548 95% CI (1,159 – 2,067)], live in urban area [PR: 1,356 95% CI (1,083 – 1,697)], fall history [PR: 1,257 95% CI (1,047 – 1,553)] are variables associated with vitamin D inadequacy. Conclusion: The prevalence of vitamin D inadequacy in the elderly population of South Sulawesi is 53.5%. Factors associated with vitamin D inadequacy are low sun exposure, sedentary physical activity, live in urban area, and fall history. Vitamin D inadequacy elderly South Sulawesi Figures Figure 1 BACKGROUND The elderly age group is susceptible to various comorbidities and geriatric syndromes that can lead to a decline in quality of life. The role of various therapeutic modalities is being investigated as an effort to prevent and manage these conditions, one of which is vitamin D. 1 Vitamin D plays an important role in maintaining bone health and also has other pleiotropic roles, namely preventing the emergence of acute and chronic diseases, including conditions related to geriatric syndromes. 1,2 Vitamin D inadequacy is still a global problem, not only in areas with low sun exposure but also in subtropical and tropical countries rich in sun, like Indonesia. 3 In Indonesia, there are several studies that describe the prevalence of vitamin D inadequacy in the elderly population. A study by Setiati, S 4 in 74 elderly women in 4 nursing homes in Jakarta and Bekasi in 2008, showed a vitamin D deficiency prevalence of 35.1%. Vera, et al 5 in 2015 in Bandung City found that only 8.3% had adequate vitamin D levels. In 2020, Husna, et al 6 conducted a study in two villages in Pasuruan Regency on 40 elderly patients and found 70% vitamin D inadequacy. Subsequently, a study by Banjuradja, et al 7 at the outpatient polyclinic of Cipto Mangunkusumo Hospital (RSCM) found that vitamin D deficiency was only 28%, with more cases of insufficiency. Lack of sun exposure and physical inactivity are personal lifestyle factors that also contribute to vitamin D deficiency. Knowledge and education factors also play a role in behavior patterns related to the consumption of vitamin D sources. 8,9 The presence of urban/rural areas also influences the classification of groupings, including several aspects such as access to education, hospitals, and others. 10 Soontrapa, et al 11,12 in 2004 and 2015 assessed differences in vitamin D levels in urban and rural areas and found higher vitamin D levels in rural areas. Isidorio, et al 13 found nearly similar vitamin D levels between urban and rural areas. Several comorbidities are related to vitamin D inadequacy. In addition, vitamin D inadequacy is also related to the process of cognitive function decline. 5,14 Impaired musculoskeletal function and metabolism can increase the risk of sarcopenia, frailty, falls, and fractures in elderly patients. 15–18 Some types of drugs interact with vitamin D, competing with CYP3A4 activity. 19 Food intake, such as fish and vitamin D supplementation, are predictors of 25(OH)D levels. 20 This research was conducted in South Sulawesi Province, specifically in Makassar City and East Luwu Regency. The largest population in Makassar City is 1,474,393, with 9.6% aged ≥60 years. 21 The population aged ≥60 in East Luwu Regency is 8.1%. 22 Research related to vitamin D in South Sulawesi is still limited. RESEARCH METHODS This study aims to determine the prevalence and factors influencing vitamin D inadequacy in the elderly population in South Sulawesi. This is a quantitative analytical study with a cross-sectional design. The study conducted in South Sulawesi Province, specifically Makassar City and East Luwu Regency, from December 2024 to May 2025. The target population consists of elderly patients within the community. The accessible population includes elderly patients present at the research location and during the study period. Sample selection was carried out using multistage cluster random sampling, utilizing a statistical calculator from https://kalkulator.id/random-number-generator/ for each region. Randomization began at the sub-district level and then proceeded to villages/urban villages. The selected locations were Benteng Village, Burau District, East Luwu Regency, and Tamalanrea Indah Urban Village, Tamalanrea District, in Makassar City. Research samples were elderly patients who met the inclusion and exclusion criteria. Inclusion criteria included patients aged 60 years or older. Exclusion criteria included patients experiencing acute medical conditions such as acute stroke, pneumonia infection, hypertensive crisis, acute heart failure, or acute exacerbation of bronchial asthma or chronic obstructive pulmonary disease at the time of examination. Patients with severe cognitive impairment and/or hearing impairment without family accompaniment were also excluded, as were patients who refused to participate in the study. The sample size for this study was determined using prevalence sample size calculations, proportion difference tests, and the rule of thumb. The questionnaires used in this study were standard, previously validated questionnaires. These included questionnaires for sun exposure, the Physical Activity Scale for the Elderly (PASE) to assess physical activity, knowledge about vitamin D, the Charlson Comorbidity Index to assess comorbidity levels, the Barthel Index for Activities of Daily Living to assess functional status, the Geriatric Depression Scale to assess the likelihood of depression, the Abbreviated Mental Test to assess cognitive status, the Mini Nutritional Assessment to evaluate nutritional status, SARC-F to assess predictive sarcopenia, and FRAIL to assess frailty. For the Food Frequency Questionnaire (FFQ), researchers were assisted by clinical nutrition specialists who based their work on the United States Department of Agricultural (USDA) food data central, using adequacy figures from the nutritional adequacy guidelines of the Ministry of Health of the Republic of Indonesia. Ethical approval for the research was submitted to the Medical Ethics Committee of the Faculty of Medicine, University of Indonesia, and research permission was obtained with No. 131/UN2.FI/ETIK/PPM.00.02/2025, along with a location permit S-6404/UN2.FI.D/PDP.00.04.04/2025. Before data collection, the study was explained to subjects and/or their caregivers. All patient data confidentiality was maintained. The study began with the recruitment of research subjects. This recruitment process involved the village head, hamlet head, local elderly program holders, and community activity coordinators. Research subjects were gathered in a central location, such as the village office, the village head's house, the hamlet head's house, near mosques, near churches, and also through house-to-house visits. All subjects who met the inclusion and exclusion criteria received a detailed explanation of the study information. Subjects underwent venipuncture for 5 cc of blood to measure total serum 25(OH)D vitamin levels. Calcidiol levels were measured using the Chemiluminescent Microparticle Immunoassay (CMIA) method. This examination was performed at Prodia laboratory, which has SNI ISO 15189 accreditation. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 20.0 and STATA software. Numerical data were presented in tables. If the data distribution was normal, data were presented as mean and standard deviation; otherwise, data were presented as median (interquartile range). Categorical data were presented nominally and as percentages. Univariate analysis was performed to determine the prevalence of vitamin D inadequacy in elderly patients in the community. Bivariate analysis was used to examine the relationship between independent and dependent variables using the chi-square test or Fisher's exact test. Data were presented with p-values, Prevalence Ratios (PR), and 95% confidence intervals (95% CI). Multivariate analysis was performed for variables with p < 0.250, proceeding to logistic regression in the initial and final models with p < 0.05, including p-values, Prevalence Ratios (PR), and 95% confidence intervals (95% CI). RESULTS A total of 303 research subjects met the inclusion criteria. Two subjects were excluded at the beginning of the study; one refused to participate, and one had a data discrepancy on their identity card. Consequently, 301 subjects were included in the analysis of these research results. Based on Table 1, the research subjects had a median age of 68 (60-95) years, with the highest proportion in the 60-69 year age range (56.15%), predominantly female (62.79%), and 60.80% married. Of all research subjects, 84.05% lived in their own homes, with the highest education level being no school/did not finish primary school (31.23%), and 40.86% were unemployed. The five most common comorbidities were hypertension, arthritis, DM, heart disease (coronary and congestive heart disease), and benign prostatic hyperplasia (BPH). Table 2 shows that vitamin D inadequacy was 53.5%, with 9.3% deficiency and 44.2% insufficiency. The lowest vitamin D level was 7.3 ng/mL and the highest was 67.7 ng/mL. The majority of subjects (53.49%) had moderate to high sun exposure, while 46.51% had low exposure. The same percentage of physical activity was found in the light and vigorous physical activity groups (34.88%). As many as 57.14% of subjects had a high comorbidity index and 42.86% had a low comorbidity index. The majority of subjects (73.09%) were fully independent, while 24.25% had moderate dependence. In the study subjects, the non-depressed group (84.39%) and those with normal cognitive status (70.76%) were more frequently found. For nutrition, normal MNA (74.75%) with non-obese BMI (62.13%) and insufficient vitamin D intake (98.67%) were the most common findings in this study. The proportions of sarcopenia and frailty in this study were most frequently found in the non-predictive sarcopenia group (84.72%) and pre-frail group (45.51%), with a history of falls of 30.56%. In the study subjects, only 6.98% consumed medications that could affect vitamin D levels. Table 3 illustrates the characteristics of the research subjects based on their place of residence in urban and rural areas. From this table, for vitamin D inadequacy, higher rates of insufficiency (51.7%) and deficiency (14.6%) were found in urban areas, with the same most common age group (60-69 years) in both locations. The most common gender in both locations was female (68.9% in urban and 56.7% in rural). Regarding education level, the highest proportion in urban areas was higher education (34.4%), while in rural areas, it was no school/did not finish primary school (46.6%). For occupation, many in urban areas were unemployed (43.0%), and in rural areas, the most common occupation was farming/gardening (52.0%). Poor knowledge was the most frequently found condition in both locations. In urban areas, 57.0% had low sun exposure, whereas in rural areas, 64.0% had moderate-to-high sun exposure. For physical activity, 51.0% in urban areas had light physical activity, while 54.0% in rural areas mostly had vigorous physical activity. For the comorbidity index variable, high comorbidity index was most common in both urban and rural areas, with nearly similar figures (57.0% and 57.3%). For functional status, depression, cognitive impairment, nutritional status, vitamin D intake, and vitamin D supplementation consumption, both urban and rural areas showed high prevalence in the fully independent functional status group (77.5% and 68.7%), likely not depressed (86.8% and 82.0%), no/normal cognitive impairment (84.8% and 56.7%), normal nutritional status (81.5% and 68.0%), insufficient vitamin D intake (97.4% and 100%), and no vitamin D supplementation (86.8% and 98.7%). The number of research subjects with obesity was 47.0% in urban areas and 28.7% in rural areas. Consumption of medications affecting vitamin D levels was found more frequently in urban areas (9.9%). For sarcopenia, frailty, and history of falls, the highest proportions were found in the non-predictive sarcopenia group (89.4% and 80.0%), pre-frail group (49.0% and 42.0%), and no history of falls (72.8% and 66.0%). From the bivariate analysis (Table 4), factors considered influential for vitamin D levels were low sun exposure, sedentary and light physical activity, urban residence, malnourished nutritional status, pre-frail and frail, and also history of falls. Variables with a p-value <0.250 were subjected to multivariate logistic regression (Table 5). In the initial model, variables included were low sun exposure, sedentary and light physical activity, urban residence, MNA at risk of malnutrition and malnutrition, vitamin D intake, sarcopenia, frail and pre-frail status, and a history of falls. Variables with non-significant values were then removed. In the final model, significant variables were found to be low sun exposure, sedentary physical activity, urban residence, and a history of falls. The results from the multivariate analysis support a behaviour- and environment-based intervention approach. DISCUSSION General Overview of Research Locations The two selected areas were Tamalanrea Indah Urban Village, Tamalanrea District, Makassar City, and Benteng Village, Burau District, East Luwu Regency. The population of Tamalanrea District is 106,262, with 9,254 individuals aged 60 years or older (8.7%), and a higher number of females (4,909 vs. 4,345). 21,23 East Luwu Regency is divided into 11 districts, consisting of 125 villages and 3 urban villages. 22 This research was conducted in Burau District. In 2023, the population of Burau District was 35,655 people, with 3,119 individuals aged 60 years or older (8.7% of the total population of Burau District), and a higher number of females compared to males (1,622 vs. 1,497). 24 Sociodemographic Characteristics of Research Subjects A total of 301 subjects were included in this study, with a median age of 68 years (interquartile range: 64-73 years). The largest age group was 60-<70 years, comprising 56.1%, with a higher number of females than males (62.8% vs. 37.2%). This proportion of the most common age group is consistent with Statistics Indoneisa data, although slightly smaller than the national percentage of 63.29%. 25 The male ratio in this study was slightly lower compared to the male population ratio in both Tamalanrea District and Burau District (47% and 48%). 23,24 In Indonesia, Suryadinata, et al 26 also found a higher proportion of women compared to men. Kweder, et al 27 conducted a study in European hospitals on elderly subjects aged ³75 years and found a higher proportion of females than males. WHO data also indicates that women have a higher life expectancy compared to men. 28 Several field conditions during the study, particularly in Burau District, coincided with the Nyepi celebration, where many men were preparing for activities, and also when the study was conducted in the morning, men had already left for work, either to gardens or rice fields. Regarding marital status, the majority of research subjects were still married (60.8%). This percentage of marital status is slightly lower compared to the national data of 66.23%. The aging process in the elderly, as an advanced stage of life, can lead to a decline in their quality of life. Therefore, the elderly need support to improve their condition. Support from a spouse will be more meaningful compared to support from others with whom no relationship is established. An elderly life partner who is always by their side provides the elderly with someone to talk to, to share happiness and sadness, thus positive support from a spouse will improve the quality of life of the elderly. 25 Most subjects lived in their own homes (84.05%), indicating a relatively high level of residential independence, although some lived with children or rented a house. The elderly have a greater sense of independence if they are in their own home. Most people prefer to live in their own homes and local environment for a long time. 29 Access to sunlight in the home environment depends on the type of dwelling, population density, and outdoor activity habits. Furthermore, those who live at home generally have a better quality of life. The education level of the study subjects was mostly found in the group who did not attend school, did not graduate from primary school, and graduated from primary school (18.9%, 12.3%, and 24.9%). Currently, the elderly population in Indonesia is still dominated by those with low educational backgrounds, with 28.89% not finishing primary school and 11.04% never having attended school. The number of research subjects who completed senior high school/vocational high school equivalent or higher was 18.7%, slightly higher than the national data (17.73%). 25 This is also one of the contributing factors to the low literacy of the research subjects regarding vitamin D (79.07%). The gender variable also contributed to the high number of unemployed research subjects (40.9%). In addition to this factor, the high number of unemployed elderly can be influenced by several other factors, such as education level and comorbidities owned by the research subjects. Chu, et al 30 found a relationship between unemployment status and increased risk of frailty, especially in those with poor health status. The elderly population who are still active, such as farming, tend to have better sun exposure, although other factors, such as wearing covered clothing, also influence this. The distribution of residences between urban and rural areas was relatively balanced, with 50.17% living in urban areas (Makassar City) and 49.83% in rural areas (East Luwu Regency). Urban and rural areas have different lifestyles that can affect vitamin D levels. This geographical factor is important because rural areas generally have better access to sun exposure, but this is not always followed by appropriate habits, such as sufficient vitamin D intake. 31 The comorbidity characteristics of the subjects showed hypertension, arthritis, DM, heart disease, and prostatic hypertrophy as the 5 most common comorbidities among the study subjects. The 2023 Indonesian Health Survey (SKI) stated that hypertension was most common in the age group 65 years and older, at 49.9%. 32 Similarly for other diseases such as DM, heart disease, and stroke. 33 Several studies have reported a relationship between suboptimal vitamin D levels and several comorbidities, such as malignancy, heart disease, DM, infections, autoimmune diseases like rheumatoid arthritis, stroke, chronic obstructive pulmonary disease (COPD), and mental health. 34 Prevalence of Vitamin D Inadequacy In this study, the inadequacy rate was 53.5%, with a deficiency of 9.3%, insufficiency of 44.2%, and a median of 29.3. Only 46.5% showed adequate vitamin D levels. These results reflect the high burden of hypovitaminosis D in the elderly population at the research sites. In Indonesia, several studies have reported the prevalence of vitamin D inadequacy in the elderly population. A study by Setiati S 4 conducted on 74 elderly women in 4 nursing homes in Jakarta and Bekasi in 2008 showed a vitamin D deficiency prevalence of 35.1%. In 2020, Husna, et al 6 conducted a study in two villages in Pasuruan Regency on 40 elderly patients and found 40% of elderly with insufficiency and 30% with vitamin D deficiency. A study by Vera, et al 5 on 240 women aged 50 years and older in the community showed a vitamin D inadequacy prevalence of 91.7%. A study by Indriyani, et al 35 on 104 geriatric patients at Posyandu lansia Surabaya showed a vitamin D deficiency prevalence of 55.8%. A study by Hidayat, et al 36 on 78 elderly outpatients at the RSCM geriatric polyclinic showed a vitamin D deficiency proportion (<50~nmol/L) of 78.2%. A randomized controlled trial (RCT) by Rizka, et al 37 on 110 geriatric outpatients at the RSCM Geriatric polyclinic showed a vitamin D insufficiency proportion of 85%, in both intervention and placebo groups. Dwimartutie, et al 38 in 2023, found that out of 95 pre-frail elderly outpatients at RSCM, only 11.6% had normal vitamin D levels. Banjuradja, et al 7 found vitamin D deficiency was only 28%, predominantly in the insufficiency group at 33.7%. Recent research in the last few years shows a similar pattern to the results of this study, where insufficiency is greater than deficiency. In Shanghai, China, in 2014, among 3,924 community study subjects aged 65-95 years, 43.1% experienced vitamin D deficiency and 38.4% experienced vitamin D insufficiency. 14 A study by Parva, et al 39 on 4,962 adult patients in the United States showed a prevalence of patients with vitamin D levels <50~nmol/L was 39.92%. Kweder, et al 27 conducted research in Europe on elderly subjects in hospitals and found an inadequacy rate of up to 85%. The research results showed a lower deficiency rate and a higher insufficiency rate compared to previous studies. When examining the results of this study, several factors could have influenced it. The results of the vitamin D knowledge questionnaire, although 79.1% did not have overall knowledge, many of the subjects knew about the importance and optimal duration of sun exposure. In addition, most subjects in this study were young elderly, and although most were unemployed, light and vigorous physical activity was frequently found in this study. Relationship between Sun Exposure and Vitamin D Inadequacy Low sun exposure was significantly associated with vitamin D inadequacy in this study (p<0.0001). Research by Kweder, et al 27 states that sun exposure and low physical activity are key factors in the occurrence of vitamin D deficiency in the elderly. A study by Husna, et al 6 on 40 female subjects aged \ge60 years showed a positive correlation between sun exposure score and serum vitamin D levels (r=0.425; p 0.006). The results of this study reinforce the evidence that UVB exposure is the main factor in vitamin D synthesis in the skin. Wu, et al 40 found that sun exposure can significantly improve vitamin D deficiency status when combined with vitamin D supplementation, which is easier and cheaper in terms of time and cost compared to using vitamin D supplementation alone in the insufficiency group. A study by Setiati, et al 4 on sun exposure in elderly women in Jakarta showed that the highest UV-B light intensity occurred between 11 AM and 1 PM. This study involved diverse ethnic and religious groups, so the body surface area exposed to the sun also influenced the results. Endogenous 25(OH)D synthesis depends on sun exposure, and this is related to latitude. 13 Relationship between Physical Activity and Vitamin D Inadequacy Subjects with sedentary physical activity had the highest risk of vitamin D inadequacy. This may reflect that activity significantly influences vitamin D status. The high proportion of sedentary behaviour in the elderly can contribute to decreased sun exposure and muscle mass. Cheng, et al 41 showed that physical exercise for more than 30 minutes/day had a protective effect against vitamin D deficiency in men, but not in women. In the group with a physical exercise duration of less than 30 minutes per day, as much as 51.88% was significantly associated with vitamin D deficiency. A study by Kluczinsky, et al 42 on 1,343 postmenopausal women showed a positive relationship between vitamin D levels and the duration of outdoor recreational physical activity. Abboud, et al 43 reported that the entry of circulating vitamin D into muscles can increase the half-life of vitamin D in the blood. Physical exercise can also increase the half-life of serum vitamin D. However, Khan, et al 44 in a systematic review and meta-analysis involving all ages, found that physical activity intervention did not independently increase vitamin D levels. Relationship between Vitamin D Knowledge and Vitamin D Inadequacy Knowledge regarding vitamin D was found to be not significant with vitamin D inadequacy in this study. Many study subjects correctly answered questions about the time and duration of sunbathing. Among all study subjects, only one used sunscreen when going outdoors. In a large study titled "What Do People Know and Believe about Vitamin D?" in France involving 60,000 participants, 38% (23,000) of whom were over 55 years old, using a validated questionnaire, found greater awareness and knowledge about vitamin D in this age group. Only 33% of this age group did not know about food sources rich in vitamin D. Interestingly, knowledge about vitamin D did not correlate with vitamin D levels in this study. 8,45 A cross-sectional study in Hong Kong involving 648 elderly subjects aged ³65 years found that vitamin D knowledge was mostly related to sun exposure. 46 A study in Korea involving participants over 50 years old, which provided education intervention to increase knowledge about osteoporosis and vitamin D, showed that among 199 participants who completed the full intervention, vitamin D inadequacy decreased from 85% to 66% using a validated questionnaire. 47 The study by Suryadinata, et al 26 in Sidoarjo found a significant relationship between diet and vitamin D knowledge. Relationship between Place of Residence and Vitamin D Inadequacy In Indonesia, the proportion of elderly people living in urban and rural areas is almost equal. 25 This study involved 150 subjects from rural areas and 151 from urban areas, and it was found that urban areas had a significant relationship with vitamin D inadequacy. Soontrapa, et al 11 in 2004 assessed the difference in vitamin D levels in elderly women in urban and rural areas and found higher vitamin D levels in rural areas. The same results were found in elderly men in Khon Kaen Province, Thailand. 12 Isidorio, et al 13 studied 25(OH)D levels in urban and rural elderly in Brazil, with an average age of 69 years, and found nearly similar vitamin D levels between urban and rural areas as long as sun exposure was sufficient. Qun, et al 14 found a relationship between vitamin D levels and place of residence (urban or suburban). Elderly people living in suburban areas had a lower prevalence of vitamin D deficiency compared to those living in urban areas. This can be influenced by differences in lifestyle, such as more outdoor activities (higher in suburban communities) and the use of sun protection (higher in urban communities). Research subjects living in rural areas had more physical activity compared to those in urban areas. Several prominent factors related to limited physical activity at home in urban areas include the lack of gardening and farming activities around the house. Additionally, urban environments tend to have high building density, with a predominance of indoor activities, thus limiting sun exposure. Relationship between Comorbidity Index and Vitamin D Inadequacy A high comorbidity index was found to be unrelated in this study. The variation in comorbidities in this study was not as extensive as in hospital-based studies. Comorbidities in this study were predominantly hypertension. The most common complaint among study subjects was musculoskeletal pain. A study by Neslihan, et al 48 on 685 geriatric patients in Turkey showed a relationship between low vitamin D levels and total comorbidity status in elderly patients. Chen, et al 41 on 1,839 individuals aged 50 years and older in Taiwan showed no significant relationship between CCI score and vitamin D deficiency with an OR of 0.933 (95% CI 0.862-1.009). Relationship between Functional Status and Vitamin D Inadequacy There was no statistically significant relationship between functional status and vitamin D inadequacy, but clinically, the trend showed that subjects with dependence had a higher tendency for vitamin D inadequacy. The research subjects included in this study were those without acute illnesses. Some of those with severe and total dependence had residual symptoms from previous illnesses, such as stroke. Boettger, et al 49 showed similar results where functional status, assessed by the Barthel index, did not show a significant relationship with vitamin D deficiency (60 years with osteoarthritis, reported that vitamin D deficiency or insufficiency was associated with worse functional status compared to those with normal vitamin D levels. Relationship between Depression and Vitamin D Inadequacy For the depression variable, no significant relationship was found. Okereke, et al 51 wrote an article on the benefits of vitamin D in improving mood and reducing the risk of depression in the elderly, involving a study of 50 subjects and excluding young age. This study found one research that did not find a significant relationship between depression outcomes between the vitamin D and placebo groups. A critical appraisal by Menon, et al 52 stated that vitamin D is inversely related to clinical depression, but still cannot recommend vitamin D supplementation because many other factors cause depression, where one of these causes may also be related to vitamin D. A study by Hoogendijk, et al 53 on 1,282 participants aged 65-95 years found lower vitamin D levels in the group experiencing depression. A study by Vidgren, et al 54 on 1,602 people aged 53-73 years showed a significant relationship between depression and vitamin D deficiency, where as many as 24.1% of patients with depression had vitamin D deficiency. The relationship between vitamin D deficiency and depression is known to be bidirectional. In depressed patients, there can be a decrease in physical activity, sun exposure, and intake, as well as lifestyle changes, all of which are related to vitamin D metabolism in the body. Furthermore, vitamin D deficiency can also be a risk factor for the onset of depression. 55 Longitudinal studies show that elderly patients with vitamin D deficiency are at risk of developing depression. The difference in results in this study may be due to the participants having low comorbidities and disabilities. All subjects with disabilities were accompanied by a caregiver. Some of those with GDS 5 ³2 results pointed to feelings of boredom and a tendency to go out rather than stay at home. Relationship between Cognitive Function and Vitamin D Inadequacy Cognitive impairment was found to be insignificant in this study. Research consistent with this finding includes that by Formiga, et al 56 , although they used subjects older than 85 years. Boettger, et al 49 , using the Mini Mental State Examination (MMSE), also found no significant relationship. These results differ from several previous studies that found a relationship between the two. Various other studies have successfully shown a relationship between vitamin D deficiency and neurodegeneration processes and a decline in cognitive status. In addition to cognitive decline, the effect of vitamin D deficiency on the central nervous system can also result in balance disorders. Low vitamin D levels are significantly found in individuals with Alzheimer's disease, Parkinson's disease, mood disorders, and cognitive decline. 16,57 In this study, this difference may be influenced by the level of education. Several sources of bias, such as language and hearing impairment, were given special attention, such as requiring a caregiver for those with hearing impairment. Relationship between Nutritional Status and Vitamin D Inadequacy In this study, nutritional status was assessed using the MNA score. A significant relationship was found in the malnourished group. From this MNA data, obesity was found in 37.87% of subjects. Elderly patients admitted to hospitals or receiving home care showed worse nutritional status compared to elderly individuals in the community. Several studies indicate that 60-80% of hospitalized elderly patients experience malnutrition. This differs from the elderly population in the community, where only 15% experience malnutrition. The prevalence of vitamin D deficiency is quite high in malnourished elderly individuals. A study by Merker, et al 58 on 828 malnourished patients showed a vitamin D deficiency prevalence of 58.2%. A study on the elderly population in South Korea showed that 37% of participants categorized as obese (BMI ³25 kg/m 2 ) had vitamin D deficiency. 59 The relationship between obesity and vitamin D deficiency is attributed to an inverse relationship between body fat mass and serum vitamin D levels. There is a hypothesis that adipose tissue accumulation can lead to absorption and sequestration of vitamin D, thus reducing the circulating metabolite levels. Other related factors are that obese groups often experience reduced mobilization and physical activity, which in turn reduces sun exposure. 60,61 Relationship between Sufficiency of Vitamin D Intake and Vitamin D Inadequacy Vitamin D intake in this study was found to be unrelated to vitamin D inadequacy. The lowest intake was 0 unit/day and the highest was 1,155.3 IU/day. Of the 301 study subjects, only 1.33% achieved an intake of 800 IU/day. The presence of vitamin D supplementation, as indicated by the questionnaire, increased the vitamin D intake adequacy rate in the study subjects. Low intake of foods rich in vitamin D, such as fish, meat, milk, and fortified foods, indicates a tendency to reduce high-fat foods, which ultimately leads to vitamin D deficiency. 62 These findings are consistent with Husna, et al 6 , who conducted research in two villages in Wonorejo and Kraton Districts, Pasuruan Regency. Another consistent study was also found by Elizondo-Montemayor, et al.63 in Mexico. Setiati, Siti 4 found that the average daily vitamin D intake was 0.6 IU. The average daily vitamin D intake in developed countries such as England, Ireland, Denmark, Netherlands, Paris, Germany, Hong Kong, Japan, and Canada is 100-200 IU/day. 64 Cianferotti, et al 65 found that the adequacy of vitamin D intake according to recommendations was still very low, even in high-risk groups for vitamin D deficiency. Kweder, et al 27 found that of all elderly subjects in their study, 90% had not consumed vitamin D supplementation in the past year. Cashman, et al 66 , in their study titled "Vitamin D deficiency in Europe: Pandemic?", stated that adequate intake is one of the major challenges in the elderly population, who often experience decreased appetite, economic limitations, or low vitamin D diets. Relationship between Medications Consumed and Vitamin D Inadequacy The variable of medications in this study was found to be unrelated to the incidence of vitamin D inadequacy (p>0.005). In this community study, the most common medication consumed by the subjects was amlodipine. Only 6.98% of the study subjects used medications that could affect vitamin D levels, such as statins. Kweder, et al 27 reported no significant relationship between statin use and vitamin D deficiency. This differs from the results by Sohl, et al 67 , who stated that medications can be a predictor of vitamin D deficiency. Relationship between Sarcopenia and Vitamin D Inadequacy In this study, predictive sarcopenia, measured using SARC-F, was found not to be significantly related to vitamin D inadequacy. This finding differs from previous research. Several studies show that vitamin D deficiency is associated with a decrease in both muscle function and strength in the elderly. A study by Visser, et al 68 (Longitudinal Aging Study Amsterdam) showed that compared to groups with sufficient vitamin D levels (>50~nmol/L), groups with low vitamin D levels (25~nmol/L) had a higher risk of sarcopenia (OR 2.57; 95% CI 1.4-4.7) when defined using handgrip strength. From the same study data, Schaap, et al 69 concluded that vitamin D deficiency significantly increases the risk of sarcopenia. 18 Relationship between Frailty and Vitamin D Inadequacy The condition of frailty is commonly found in a significant number of elderly individuals. In the community-dwelling elderly group, 10.7% of individuals aged 65 years and older have a frail condition. The results of this study showed no significant findings in the multivariate analysis. Buchebner, et al 70 in 2019 found no significant relationship between 25OHD levels and frailty in elderly women aged 85 years. The relationship between vitamin D deficiency and frailty is multifactorial. A meta-analysis by Zhou, et al 71 across 7 studies involving 17,815 individuals showed an increased risk of frailty associated with low vitamin D levels (pooled-OR 1.27; 95% CI 1.17-1.38). Marcos-Perez, et al 72 also found similar results. Vitamin D deficiency is associated with an increased risk of falls, increased inflammatory processes, and decreased muscle strength and physical performance. Additionally, frailty can also lead to decreased vitamin D levels due to reduced outdoor physical activity and sun exposure. 71 Relationship between History of Falls in the Last Year and Vitamin D Inadequacy A history of falls was significantly associated with vitamin D inadequacy. The prevalence of vitamin D insufficiency was found to be higher in the elderly group with a history of falls compared to the group without a history of falls (70% vs 40%). 73 A study by Bischoff-Ferrari, et al 74 showed a significant relationship between vitamin D levels £12ng/mL and thigh muscle extension strength. A study by Annweiler, et al 75 showed a significant relationship between low vitamin D levels and low quadriceps muscle strength and handgrip strength. Individuals with low vitamin D levels tend to have poor body balance and neuromuscular function, thereby increasing the risk of falls. Strengths and Limitations of the Study This study has several strengths supported by internal and external validity, as well as the clinical relevance of the obtained results. The research topic is an important and current issue, especially regarding local data on vitamin D status, which is still limited in South Sulawesi. This study also provides significant scientific contributions to the development of regional epidemiological data related to vitamin D inadequacy in Eastern Indonesia. The sufficiently large number of subjects provided good statistical power in both bivariate and multivariate analyses. Vitamin D level measurements were performed in a standardized laboratory, which increased data validity and reduced potential measurement bias. The multidimensional approach used in this study allowed for comprehensive data analysis of various determinants affecting vitamin D status. The use of multivariate analysis with several logistic regression models strengthened the conclusions regarding the main determinants of vitamin D inadequacy. Based on the literature review, this study is the first in Indonesia to include urban/rural variables and vitamin D knowledge linked to vitamin D inadequacy in the elderly community. This study is also the first in East Luwu Regency and Makassar City to assess vitamin D inadequacy with a comprehensive geriatric assessment. However, this study also has limitations, namely the cross-sectional design used does not allow the researchers to conclude causal relationships. Recall bias may also occur in this study, especially for questionnaires on sun exposure, physical activity, and frequency of vitamin D nutrient intake. In this study, low sun exposure was found to be highly influential on the incidence of inadequacy, but this study did not measure the intensity and wavelength of UV light. CONCLUSION * The prevalence of vitamin D inadequacy in the elderly population of South Sulawesi is 53.5%, with insufficiency at 44.2% and deficiency at 9.3%. * Low sun exposure, sedentary physical activity, urban residence, and a history of falls are associated with vitamin D inadequacy in the elderly population of South Sulawesi. Declarations The authors declare that we have no competing interests. There is no funder for this research. Author Contribution Isman, Haniyyah -- Prepared the main concept, took the data, analyzed and interpreted dataDwimartutie, N -- Prepared the main concept and interpreted dataSetiati, S -- Prepared the main concept and interpreted dataNugroho, P -- Prepared the main concept and interpreted data References Aspell N, Laird E, Healy M, Shannon T, Lawlor B, O’Sullivan M. The prevalence and determinants of vitamin D status in community-dwelling older adults: Results from the English Longitudinal Study of Ageing (ELSA). Nutrients . 2019;11(6):1253. Hye YJ, Mu YK, Jung MK, Do WK, Chae BK. Vitamin D deficiency in nursing home elderly in Korea. Ann Geriatr Med Res . 2016;20(2):102-107. Ronaldson A, Arias de la Torre J, Gaughran F, et al. Prospective Associations between Vitamin D and Depression in Middle-Aged Adults: Findings from the UK Biobank Cohort. Psychol Med . 2022;52(10):1866-1874. Setiati S. Vitamin D Status Among Indonesia Elderly Women Living in Instutionalized Care Units. Acta Med Indones . 2008;40(2):78-83. Vera V, Setiati S, Govinda A. Determinan Diagnostik Klinis Defisiensi Vitamin D pada Wanita Berusia Lebih dari 50 Tahun. J Penyakit Dalam Indones . 2015;2(1). Husna K, Widajanti N, Sumarmi S, Firdausi H. Hubungan antara Skor Paparan Matahari dan Asupan Vitamin D dengan Kadar 25 (OH)D Serum pada Wanita Usia Lanjut. J Penyakit Dalam Indones . 2021;8(2):63-71. Banjuradia I, Dwimartutie N, Purnamasari D, Harimurti K. Prevalence and Diagnostic Determinants of Vitamin D Deficiency in Outpatient Elderly Patients . Indonesia University; 2023. Deschasaux M, Souberbielle JC, Partula V, et al. What Do People Know and Believe about Vitamin D. Nutrients . 2016;8(11):1-15. Lee H, Kim KN, Lim YH, Hong YC. Interaction of Vitamin D and Smoking on Inflammatory Markers in the Urban Elderly. Prev Med Public Health . 2015;48(5):249-256. Heriyana A, Pazanuddin AF, Rosiadi A, et al. Peraturan Kepala Badan Pusat Statistik Nomor 120 Tahun 2020 Tentang Klasifikasi Desa Perkotaan Dan Perdesaan Di Indonesia 2020 Buku 2 Jawa .; 2021. Soontrapa S, Soontrapa S, Chailurkit LO. The Difference in Vitamin D Status between Urban and Rural Elderly Women of Khon Kaen Province, Thailand. Srinagarind Med J . 2004;19(2):67-74. Soontrapa S, Soontrapa S, Chaikitpinyo S. Prevalence of Vitamin D Insufficiency among Elderly Males Living in Rural Khon Kaen Province, Northeast Thailand. J Med Assoc Thai . 2015;98(8):S21-S25. Isidorio U de A, Vilar de Assis E, Lacerda SNB, et al. Relationship between Lifestyle and Residence Area with 25(OH)D Levels in Older Adults. Int J Environ Res Public Health . 2023;20(1):1-11. Qun C, Yanping D, Wei H, et al. Factors associated to serum 25 - hydroxyvitamin D levels among older adult populations in urban and suburban communities in Shanghai, china. BMC Geriatr . 2017;17(246):1-10. Bruyere O, Cavalier E, Souberbielle JC, et al. Effects of Vitamin D in the Elderly Population: Current Status and Perspectives. Arch Public Health . 2014;72(1):1-10. Uchitomi R, Oyabu M, Kamei Y. Vitamin D and Sarcopenia: Potential of Vitamin D Supplementation in Sarcopenia Prevention and Treatment. Nutrients . 2020;12(3189):1-12. Jianghua Z, Pan H, Ping L, et al. Association of Vitamin D Deficiency and Frailty: A Systematic Review and Meta - Analysis. Maturitas . 2016;94:70-76. Sultan S, Taimuri U, Basnan SA, et al. Low Vitamin D and Its Association with Cognitive Impairment and Dementia. J Aging Res . Published online April 30, 2020:1-10. Grober U. Common Drugs as Vitamin D Disruptor. J Transl Sci . 2020;6:1-4. Al-Daghri NM, Aljohani N, Al - Attas OS, et al. Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults. Int J Clin Exp Pathol . 2015;8(7):8480-8486. Badan Pusat Statistik Kota Makassar. Kota Makassar Dalam Angka 2024 .; 2024. Badan Pusat Statistik. Kabupaten Luwu Timur Dalam Angka 2024 .; 2024. Badan Pusat Statistik Kota Makassar. Kecamatan Tamalanrea Dalam Angka 2024 .; 2024. Badan Pusat Statistik Kabupaten Luwu Timur. Kecamatan Burau Dalam Angka .; 2024. Badan Pusat Statistik. Statistik Penduduk Lanjut Usia 2024 .; 2024. Suryadinata RV, Lorensia A. Food Frequency, Knowledge about Vitamin D and Obesity among Elderly. Amerta Nutr . Published online 2020:43-48. Kweder H, Eldi H. Vitamin D Deficiency in Elderly: Risk Factors and Drugs Impact on Vitamin D Status. Avicenna J Med . 2018;2018(8):139-146. World Health Organization. World Health Statistics 2025: Monitoring Health for the SDGs, Sustainable Development Goals. ; 2025. Aclan R, Deoge S, Block H, Lane R, Laver K. Middle Aged and Older Adult’s Perspectives of Their Own Home Environment: A Review of Qualitative Studies and Meta-Synthesis. BMC Geriatrics volume . 2023;23. Chu WM, Ho HE, Yeh CJ, Tsan YT, Lee SH, Lee MC. Late-career unemployment and risk of frailty among older adults in Taiwan: An 8-year population-based cohort study. Geriatr Gerontol Int . 2021;21(4):353-358. Griffin TP, Wall D, Blake L, et al. Higher Risk of Vitamin D Insufficiency/Deficiency for Rural than Urban Dwellers. J Steroid Biochem Mol Biol . Published online 2020. Kementerian Kesehatan Republik Indonesia. Survei Kesehatan Indonesia (SKI) 2023 Dalam Angka .; 2023. Pusat Data dan Teknologi Informasi Kementerian Kesehatan RI. Infodatin: Lansia Berdaya, Bangsa Sejahtera .; 2022. Cahyawati WASN, Yasmina A, Suarjana IN, Rudiansyah M, Henry J. Correlation Between Vitamin D Levels and Charlson Comorbidity Index with Sarcopenia in Geriatric Patients. SEEJPH . 2024;25:901-907. Indrayani HW, Widajanti N, Firdausi H. The Relationship Between Serum Calcidiol Deficiency and the Degree of Sarcopenia in Elderly Communities in Surabaya. J penyakit dalam Indones . 2020;7(1):29-33. Hidayat R, Setaiti S, Soeondo Pradana. The Association Between Vitamin D Deficiency and Type 2 Diabetes Mellitus in Elderly Patients. Acta Med Indones . 2010;42(3):123-129. Rizka A, Setiati S, Harimurti K, Sadikin M, Mansur IG. Effect of Alfacalcidol on Inflammatory Markers and T Cell Subsets in Elderly with Frailty Syndrome: A Double Blind Randomized Controlled Trial . Acta med Indones . 2018;50(3):215-221. Dwimartutie N, Setiati S, Tamin TZ, et al. Vitamin D levels in pre-frail older adults and its correlation with hand grip strength. Acta Med Indones . 2023;55(2):172-179. Parva NR, Tadepalli S, Singh P, et al. Prevalence of Vitamin D Deficiency and Associated Risk Factors in the US Population (2011 - 2012). Cureus . 2018;10(6):1-10. Wu SE, Chen WL. Moderate Sun Exsposure Is the Complementor in Isufficient Vitamin D Consumer. FrontNutr . 2022;9:1-11. Qun C, Yanping D, Wei H, et al. Factors Associated to Serum 25-Hydroxyvitamin D Levels among Older Adult Populations in Urban and Suburban Communities in Shanghai, China. BMC Geriatr . 2017;17(246):1-10. Kluczynski MA, Lamonte MJ, Mares JA, et al. Duration of Physical Activity and Serum 25 - Hydroxyvitamin D Status of Postmenopousal Women. Ann Epidemiol . 2011;21(6):440-449. Abboud M, Puglisi DA, Davies BN, et al. Evidence for a Specific Uptake and Retention Mechanism for 25 - Hydroxyvitamin D (25OHD) in Skeletal Muscle Cells. Endocrinology . 2013;154(9):3022-3030. Khan SR, Claeson M, Khan A, Neale RE. The Effect of Physical Activity on Vitamin D: A Systematic Review and Meta-Analysis of Intervention Studies in Humans. Public Health Res Pract . 2024;7. Oudshoorn C, Hartholt KA, PTM van Leeuwen J, Colin EM, Velde N van der, Cammen TJ van der. Better Knowledge on Vitamin D and Calcium in Older People is Associated with A Higher Serum Vitamin D Level and A Higher Daily Dietary Calcium Intake. Health Educ J . 2012;71(4):474-482. Christides T. Older Adults’s Beliefs, Knowledge and Preferences for Achieving Healthy Vitamin D Status: A Narrative Review. Geraitrics . 2018;3(26):1-17. Ki-Soo P, Jun-II Y, Ha-Young K, Sunmee J, Yongsoon P, Yong-Chan H. Education and Exercise Program Improves Osteoporosis Knowledge and Changes Calcium and Vitamin D Dietary Intake in community Dwelling Elderly. BMC Public Health . 2017;17(966):1-8. Gokcen N, Benlidayi IC, Kocaer A, Basaran S. Association Between VItamin D Level and Total Comorbidity Status in Geriatric Patients. Turk J Geriatr . 2018;21(4):536-543. Boettger S, Angersbach B, Klimek C, Wanderley A, Shaibekov A, Sieske L. Prevalence and Predictors of Vitamin D-Deficiency in Frail Older Hospitalized Patients. BMC Geriatr . 2018;18:1-6. Montemor CN, Fernandes MTP, Marquez AS, Poli - Frederico RC, Alexandre da Silva R, Fernandes KB. Vitamin D Deficiency, Functional Status, and Balance in Older Adults with Osteoarthritis. World J Clin Cases . 2021;9(31):9491-9499. Okereke OI, Singh A. The Role of Vitamin D in the Prevention of Late Life Depression. J Affect Disord . 2016;198:1-14. Menon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. IndianJPsycholMed . 2020;42(1). Hoogendijk WJG, Lips P, Dik MG, Deeg DJH, Baekman ATF, Pennix BWJH. Depression Is Associated with Decreased 25-Hydroxyvitamin D and Increased Parathyroid Hormone Levels in Older Adults. Arch Gen Psychiatry . 2008;65(5):508-512. Vidgren M, Virtanen JK, Tolmunen T, et al. Serum Concentrations of 25-Hydroxyvitamin D and Depression in A General Middle-Aged to Elderly Population in Finland. J Nutr Health Aging . 2018;22(1):159-164. Oliveira C de, Hirani V, Biddulph JP. Associations Between Vitamin D Levels and Depressive Symptoms in Later Life: Evidence from the English Longitudinal Study of Ageing (ELSA). J Gerontol A Biol Sci Med Sci . 2018;73(10):1377-1382. Formiga F, Ferrer A, Almeda J, San Jose A, Gil A, Pujol R. Utility of Geriatric Assessment Tools to Identify 85-Years Old Subjects with Vitamin D Deficiency. J Nutr Health Aging . 2011;15:110-114. Kupisz-Urbańska M, Łukaszkiewicz J, Marcinowska-Suchowierska. Vitamin D in Elderly. IntechOpen . Published online 2021:1-15. Merker M, Amsler A, Pereira R, et al. Vitamin D Deficiency is Highly Prevalent in Malnourished Inpatients and Associated with Higher Mortality. Medicine . 2019;98(48):1-9. Sun HK, Jung EO, Dong WS, et al. The Factors Associated with Vitamin D Deficiency in Community Dwelling Elderly in Korea. Nutr Res Pract . 2018;12(5):387-395. Holick MF, Binkley NC, Bischoff-Ferrai HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guidline. J Clin Endocrinol Metab . 2011;96(7):1911-1930. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations Abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc . 2014;62(1):147-152. Rimahardika R, Subagio HW, Wijayanti HS. Asupan Vitamin D Dan Paparan Sinar Matahari Pada Orang Yang Bekerja Di Dalam Ruangan Dan Di Luar Ruangan. Journal of Nutrition College . 2017;6(4):333. doi:10.14710/jnc.v6i4.18785 Elizondo-Montemayor L, Castillo E, Rodriguez-Lopez C, Vialrreal-Calderon J, Gomez-Carmona M, Tenorio-Martinez S. Seasonal Variation in Vitamin D in Association with Age, Inflammatory Cytokines, Anthropometric Parameters, and Lifestyle Factos in Older Adults. Mediat of inflam . Published online 2017. Lips P. Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications. Endocr Rev . 2001;22(4):477-501. Cianferotti L, Parri S, Civinini R, Brandi ML. The Use of Cholecalciferol in Patients with Hip Fracture. Clin Cases Miner Bone Metab . 2017;14(1):48-53. Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D Deficiency in Europe: Pandemic? Am J Clin Nutr . 2016;103(4):1033-1044. Sohl E, M. van Schoor N, T de Jongh R, Visser M, Deeg DJP, Lips P. Vitamin D Status Is Associated With Functional Limitations and Functional Decline in Older Individuals. J Clin Endocrinol Metab . 2013;98(9):1483-1490. Visser M, Deeg DJ, 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 . 2003;88(12):5766-5772. Schaap LA, M van Schoor N, Lips P, Visser M. Associations of Sarcopenia Definitions, and Their Components, with the Incidence of Recurrent Falling and Fractures: the Longitudinal Aging Study Amsterdam. J Gerontol A Biol Sci Med Sci . 2018;73(9):1199-1204. Buchebner D, Bartosch P, Malmgren L, McGuigan FE, Gerdhem P, Akesson KE. Association Between Vitamin D, Frailty, and Progression of Frailty in Community - Dwelling Older Women. J Clin Endocrinol Metab . 2019;104(12):6139-6147. Zhou J, Huang P, Liu P, et al. Association of Vitamin D Deficiency and Frailty: A Systematic Review and Meta - Analysis. Maturitas . 2016;94:70-76. Marcos-Perez D, Sanchez-Flores M, Proietti S, et al. Low Vitamin D Levels and Frailty Status in Older Adults: A Systematic Review and Meta-Analysis. Nutrients . 2020;12(8):1-20. Annweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O. Fall Prevention and Vitamin D in the Elderly: An Overview of the Key ROle of the non-Bone Effects. J Neuroneng Rehabil . 2010;7(50):1-13. Bischoff H, Stahelin H, Urscheler N, et al. Muscle Strength in the Elderly: Its Relation to Vitamin D Metabolites. Arch Phys Med Rehabil . 1999;80(1):54-58. Annweiler C, Schott-Petelaz AM, Berrut G, et al. Vitamin D deficiency-realted Quadriceps Weakness: Results of the Epidemiologie De l’Osteoporose Cohort. J Am Geriatr Soc . 2009;57(2):368-369. Tables Table 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7024040","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":479304803,"identity":"7f6e25a3-ba9b-4538-9394-84c96c09fb50","order_by":0,"name":"Haniyyah Isman","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Haniyyah","middleName":"","lastName":"Isman","suffix":""},{"id":479304805,"identity":"8819ba19-c0a8-433e-839c-ccc01c2a64c9","order_by":1,"name":"Noto Dwimartutie","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Noto","middleName":"","lastName":"Dwimartutie","suffix":""},{"id":479304806,"identity":"f5612806-8ae6-4b91-8335-bce9462e8b17","order_by":2,"name":"Siti Setiati","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Siti","middleName":"","lastName":"Setiati","suffix":""},{"id":479304807,"identity":"706bcdad-4a16-4ed7-b5d5-509f6334be8c","order_by":3,"name":"Pringgodigdo Nugroho","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Pringgodigdo","middleName":"","lastName":"Nugroho","suffix":""}],"badges":[],"createdAt":"2025-07-02 01:23:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7024040/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7024040/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85912467,"identity":"12465008-2867-4c68-9b86-efd219871863","added_by":"auto","created_at":"2025-07-03 06:00:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":195986,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Tamalanrea\u003csup\u003e23\u003c/sup\u003e and Burau District\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7024040/v1/cc752ccbd440fa7a7dadff54.png"},{"id":90506152,"identity":"d8333712-a864-4aa9-b1b9-539c8052005e","added_by":"auto","created_at":"2025-09-03 12:39:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1099462,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7024040/v1/f86a4123-a2a0-4689-a41c-1c36f76e7a25.pdf"},{"id":85912463,"identity":"9e73c9c7-6f41-4077-86de-c378fc5aadea","added_by":"auto","created_at":"2025-07-03 06:00:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46495,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7024040/v1/4ba5930c1f1252f695df0021.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Factors Associated with Vitamin D Inadequacy in the Elderly Population of South Sulawesi","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe elderly age group is susceptible to various comorbidities and geriatric syndromes that can lead to a decline in quality of life. The role of various therapeutic modalities is being investigated as an effort to prevent and manage these conditions, one of which is vitamin D.\u003csup\u003e1\u003c/sup\u003e Vitamin D plays an important role in maintaining bone health and also has other pleiotropic roles, namely preventing the emergence of acute and chronic diseases, including conditions related to geriatric syndromes. \u003csup\u003e1,2\u003c/sup\u003e Vitamin D inadequacy is still a global problem, not only in areas with low sun exposure but also in subtropical and tropical countries rich in sun, like Indonesia. \u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn Indonesia, there are several studies that describe the prevalence of vitamin D inadequacy in the elderly population. A study by Setiati, S \u003csup\u003e4\u003c/sup\u003e in 74 elderly women in 4 nursing homes in Jakarta and Bekasi in 2008, showed a vitamin D deficiency prevalence of 35.1%. Vera, et al \u003csup\u003e5\u003c/sup\u003e in 2015 in Bandung City found that only 8.3% had adequate vitamin D levels. In 2020, Husna, et al \u003csup\u003e6\u003c/sup\u003e conducted a study in two villages in Pasuruan Regency on 40 elderly patients and found 70% vitamin D inadequacy. Subsequently, a study by Banjuradja, et al\u003csup\u003e7\u003c/sup\u003e at the outpatient polyclinic of Cipto Mangunkusumo Hospital (RSCM) found that vitamin D deficiency was only 28%, with more cases of insufficiency.\u003c/p\u003e \u003cp\u003eLack of sun exposure and physical inactivity are personal lifestyle factors that also contribute to vitamin D deficiency. Knowledge and education factors also play a role in behavior patterns related to the consumption of vitamin D sources.\u003csup\u003e8,9\u003c/sup\u003e The presence of urban/rural areas also influences the classification of groupings, including several aspects such as access to education, hospitals, and others.\u003csup\u003e10\u003c/sup\u003e Soontrapa, et al\u003csup\u003e11,12\u003c/sup\u003e in 2004 and 2015 assessed differences in vitamin D levels in urban and rural areas and found higher vitamin D levels in rural areas. Isidorio, et al\u003csup\u003e13\u003c/sup\u003e found nearly similar vitamin D levels between urban and rural areas. Several comorbidities are related to vitamin D inadequacy. In addition, vitamin D inadequacy is also related to the process of cognitive function decline.\u003csup\u003e5,14\u003c/sup\u003e Impaired musculoskeletal function and metabolism can increase the risk of sarcopenia, frailty, falls, and fractures in elderly patients.\u003csup\u003e15–18\u003c/sup\u003e Some types of drugs interact with vitamin D, competing with CYP3A4 activity.\u003csup\u003e19\u003c/sup\u003e Food intake, such as fish and vitamin D supplementation, are predictors of 25(OH)D levels.\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis research was conducted in South Sulawesi Province, specifically in Makassar City and East Luwu Regency. The largest population in Makassar City is 1,474,393, with 9.6% aged ≥60 years.\u003csup\u003e21\u003c/sup\u003e The population aged ≥60 in East Luwu Regency is 8.1%.\u003csup\u003e22\u003c/sup\u003e Research related to vitamin D in South Sulawesi is still limited.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"RESEARCH METHODS","content":"\u003cp\u003eThis study aims to determine the prevalence and factors influencing vitamin D inadequacy in the elderly population in South Sulawesi. This is a quantitative analytical study with a cross-sectional design. The study conducted in South Sulawesi Province, specifically Makassar City and East Luwu Regency, from December 2024 to May 2025. The target population consists of elderly patients within the community. The accessible population includes elderly patients present at the research location and during the study period. Sample selection was carried out using multistage cluster random sampling, utilizing a statistical calculator from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kalkulator.id/random-number-generator/\u003c/span\u003e\u003cspan address=\"https://kalkulator.id/random-number-generator/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e for each region. Randomization began at the sub-district level and then proceeded to villages/urban villages. The selected locations were Benteng Village, Burau District, East Luwu Regency, and Tamalanrea Indah Urban Village, Tamalanrea District, in Makassar City. Research samples were elderly patients who met the inclusion and exclusion criteria. Inclusion criteria included patients aged 60 years or older. Exclusion criteria included patients experiencing acute medical conditions such as acute stroke, pneumonia infection, hypertensive crisis, acute heart failure, or acute exacerbation of bronchial asthma or chronic obstructive pulmonary disease at the time of examination. Patients with severe cognitive impairment and/or hearing impairment without family accompaniment were also excluded, as were patients who refused to participate in the study.\u003c/p\u003e\u003cp\u003eThe sample size for this study was determined using prevalence sample size calculations, proportion difference tests, and the rule of thumb. The questionnaires used in this study were standard, previously validated questionnaires. These included questionnaires for sun exposure, the Physical Activity Scale for the Elderly (PASE) to assess physical activity, knowledge about vitamin D, the Charlson Comorbidity Index to assess comorbidity levels, the Barthel Index for Activities of Daily Living to assess functional status, the Geriatric Depression Scale to assess the likelihood of depression, the Abbreviated Mental Test to assess cognitive status, the Mini Nutritional Assessment to evaluate nutritional status, SARC-F to assess predictive sarcopenia, and FRAIL to assess frailty. For the Food Frequency Questionnaire (FFQ), researchers were assisted by clinical nutrition specialists who based their work on the United States Department of Agricultural (USDA) food data central, using adequacy figures from the nutritional adequacy guidelines of the Ministry of Health of the Republic of Indonesia.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e for the research was submitted to the Medical Ethics Committee of the Faculty of Medicine, University of Indonesia, and research permission was obtained with No. 131/UN2.FI/ETIK/PPM.00.02/2025, along with a location permit S-6404/UN2.FI.D/PDP.00.04.04/2025. Before data collection, the study was explained to subjects and/or their caregivers. All patient data confidentiality was maintained.\u003c/p\u003e\u003cp\u003eThe study began with the recruitment of research subjects. This recruitment process involved the village head, hamlet head, local elderly program holders, and community activity coordinators. Research subjects were gathered in a central location, such as the village office, the village head's house, the hamlet head's house, near mosques, near churches, and also through house-to-house visits. All subjects who met the inclusion and exclusion criteria received a detailed explanation of the study information. Subjects underwent venipuncture for 5 cc of blood to measure total serum 25(OH)D vitamin levels. Calcidiol levels were measured using the Chemiluminescent Microparticle Immunoassay (CMIA) method. This examination was performed at Prodia laboratory, which has SNI ISO 15189 accreditation.\u003c/p\u003e\u003cp\u003eStatistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 20.0 and STATA software. Numerical data were presented in tables. If the data distribution was normal, data were presented as mean and standard deviation; otherwise, data were presented as median (interquartile range). Categorical data were presented nominally and as percentages. Univariate analysis was performed to determine the prevalence of vitamin D inadequacy in elderly patients in the community. Bivariate analysis was used to examine the relationship between independent and dependent variables using the chi-square test or Fisher's exact test. Data were presented with p-values, Prevalence Ratios (PR), and 95% confidence intervals (95% CI). Multivariate analysis was performed for variables with p \u0026lt; 0.250, proceeding to logistic regression in the initial and final models with p \u0026lt; 0.05, including p-values, Prevalence Ratios (PR), and 95% confidence intervals (95% CI).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 303 research subjects met the inclusion criteria. Two subjects were excluded at the beginning of the study; one refused to participate, and one had a data discrepancy on their identity card. Consequently, 301 subjects were included in the analysis of these research results.\u003c/p\u003e\n\u003cp\u003eBased on Table 1, the research subjects had a median age of 68 (60-95) years, with the highest proportion in the 60-69 year age range (56.15%), predominantly female (62.79%), and 60.80% married. Of all research subjects, 84.05% lived in their own homes, with the highest education level being no school/did not finish primary school (31.23%), and 40.86% were unemployed. The five most common comorbidities were hypertension, arthritis, DM, heart disease (coronary and congestive heart disease), and benign prostatic hyperplasia (BPH).\u003c/p\u003e\n\u003cp\u003eTable 2 shows that vitamin D inadequacy was 53.5%, with 9.3% deficiency and 44.2% insufficiency. The lowest vitamin D level was 7.3 ng/mL and the highest was 67.7 ng/mL. The majority of subjects (53.49%) had moderate to high sun exposure, while 46.51% had low exposure. The same percentage of physical activity was found in the light and vigorous physical activity groups (34.88%). As many as 57.14% of subjects had a high comorbidity index and 42.86% had a low comorbidity index. The majority of subjects (73.09%) were fully independent, while 24.25% had moderate dependence. In the study subjects, the non-depressed group (84.39%) and those with normal cognitive status (70.76%) were more frequently found. For nutrition, normal MNA (74.75%) with non-obese BMI (62.13%) and insufficient vitamin D intake (98.67%) were the most common findings in this study. The proportions of sarcopenia and frailty in this study were most frequently found in the non-predictive sarcopenia group (84.72%) and pre-frail group (45.51%), with a history of falls of 30.56%. In the study subjects, only 6.98% consumed medications that could affect vitamin D levels.\u003c/p\u003e\n\u003cp\u003eTable 3 illustrates the characteristics of the research subjects based on their place of residence in urban and rural areas. From this table, for vitamin D inadequacy, higher rates of insufficiency (51.7%) and deficiency (14.6%) were found in urban areas, with the same most common age group (60-69 years) in both locations. The most common gender in both locations was female (68.9% in urban and 56.7% in rural). Regarding education level, the highest proportion in urban areas was higher education (34.4%), while in rural areas, it was no school/did not finish primary school (46.6%). For occupation, many in urban areas were unemployed (43.0%), and in rural areas, the most common occupation was farming/gardening (52.0%). Poor knowledge was the most frequently found condition in both locations. In urban areas, 57.0% had low sun exposure, whereas in rural areas, 64.0% had moderate-to-high sun exposure. For physical activity, 51.0% in urban areas had light physical activity, while 54.0% in rural areas mostly had vigorous physical activity. For the comorbidity index variable, high comorbidity index was most common in both urban and rural areas, with nearly similar figures (57.0% and 57.3%). For functional status, depression, cognitive impairment, nutritional status, vitamin D intake, and vitamin D supplementation consumption, both urban and rural areas showed high prevalence in the fully independent functional status group (77.5% and 68.7%), likely not depressed (86.8% and 82.0%), no/normal cognitive impairment (84.8% and 56.7%), normal nutritional status (81.5% and 68.0%), insufficient vitamin D intake (97.4% and 100%), and no vitamin D supplementation (86.8% and 98.7%). The number of research subjects with obesity was 47.0% in urban areas and 28.7% in rural areas. Consumption of medications affecting vitamin D levels was found more frequently in urban areas (9.9%). For sarcopenia, frailty, and history of falls, the highest proportions were found in the non-predictive sarcopenia group (89.4% and 80.0%), pre-frail group (49.0% and 42.0%), and no history of falls (72.8% and 66.0%).\u003c/p\u003e\n\u003cp\u003eFrom the bivariate analysis (Table 4), factors considered influential for vitamin D levels were low sun exposure, sedentary and light physical activity, urban residence, malnourished nutritional status, pre-frail and frail, and also history of falls.\u003c/p\u003e\n\u003cp\u003eVariables with a p-value \u0026lt;0.250 were subjected to multivariate logistic regression (Table 5). In the initial model, variables included were low sun exposure, sedentary and light physical activity, urban residence, MNA at risk of malnutrition and malnutrition, vitamin D intake, sarcopenia, frail and pre-frail status, and a history of falls. Variables with non-significant values were then removed. In the final model, significant variables were found to be low sun exposure, sedentary physical activity, urban residence, and a history of falls. The results from the multivariate analysis support a behaviour- and environment-based intervention approach.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eGeneral Overview of Research Locations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two selected areas were Tamalanrea Indah Urban Village, Tamalanrea District, Makassar City, and Benteng Village, Burau District, East Luwu Regency. The population of Tamalanrea District is 106,262, with 9,254 individuals aged 60 years or older (8.7%), and a higher number of females (4,909 vs. 4,345).\u003csup\u003e21,23\u003c/sup\u003e East Luwu Regency is divided into 11 districts, consisting of 125 villages and 3 urban villages.\u003csup\u003e22\u003c/sup\u003e This research was conducted in Burau District. In 2023, the population of Burau District was 35,655 people, with 3,119 individuals aged 60 years or older (8.7% of the total population of Burau District), and a higher number of females compared to males (1,622 vs. 1,497).\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics of Research Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 301 subjects were included in this study, with a median age of 68 years (interquartile range: 64-73 years). The largest age group was 60-\u0026lt;70 years, comprising 56.1%, with a higher number of females than males (62.8% vs. 37.2%). This proportion of the most common age group is consistent with Statistics Indoneisa data, although slightly smaller than the national percentage of 63.29%.\u003csup\u003e25\u003c/sup\u003e The male ratio in this study was slightly lower compared to the male population ratio in both Tamalanrea District and Burau District (47% and 48%).\u003csup\u003e23,24\u003c/sup\u003e In Indonesia, Suryadinata, et al\u003csup\u003e\u0026nbsp;26\u003c/sup\u003e also found a higher proportion of women compared to men. Kweder, et al\u003csup\u003e\u0026nbsp;27\u003c/sup\u003e conducted a study in European hospitals on elderly subjects aged ³75 years and found a higher proportion of females than males. WHO data also indicates that women have a higher life expectancy compared to men.\u003csup\u003e28\u003c/sup\u003e Several field conditions during the study, particularly in Burau District, coincided with the Nyepi celebration, where many men were preparing for activities, and also when the study was conducted in the morning, men had already left for work, either to gardens or rice fields.\u003c/p\u003e\n\u003cp\u003eRegarding marital status, the majority of research subjects were still married (60.8%). This percentage of marital status is slightly lower compared to the national data of 66.23%. The aging process in the elderly, as an advanced stage of life, can lead to a decline in their quality of life. Therefore, the elderly need support to improve their condition. Support from a spouse will be more meaningful compared to support from others with whom no relationship is established. An elderly life partner who is always by their side provides the elderly with someone to talk to, to share happiness and sadness, thus positive support from a spouse will improve the quality of life of the elderly.\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eMost subjects lived in their own homes (84.05%), indicating a relatively high level of residential independence, although some lived with children or rented a house. The elderly have a greater sense of independence if they are in their own home. Most people prefer to live in their own homes and local environment for a long time.\u003csup\u003e29\u003c/sup\u003e Access to sunlight in the home environment depends on the type of dwelling, population density, and outdoor activity habits. Furthermore, those who live at home generally have a better quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe education level of the study subjects was mostly found in the group who did not attend school, did not graduate from primary school, and graduated from primary school (18.9%, 12.3%, and 24.9%). Currently, the elderly population in Indonesia is still dominated by those with low educational backgrounds, with 28.89% not finishing primary school and 11.04% never having attended school. The number of research subjects who completed senior high school/vocational high school equivalent or higher was 18.7%, slightly higher than the national data (17.73%).\u003csup\u003e25\u003c/sup\u003e This is also one of the contributing factors to the low literacy of the research subjects regarding vitamin D (79.07%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe gender variable also contributed to the high number of unemployed research subjects (40.9%). In addition to this factor, the high number of unemployed elderly can be influenced by several other factors, such as education level and comorbidities owned by the research subjects. Chu, et al\u003csup\u003e30\u003c/sup\u003e found a relationship between unemployment status and increased risk of frailty, especially in those with poor health status. The elderly population who are still active, such as farming, tend to have better sun exposure, although other factors, such as wearing covered clothing, also influence this.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The distribution of residences between urban and rural areas was relatively balanced, with 50.17% living in urban areas (Makassar City) and 49.83% in rural areas (East Luwu Regency). Urban and rural areas have different lifestyles that can affect vitamin D levels. This geographical factor is important because rural areas generally have better access to sun exposure, but this is not always followed by appropriate habits, such as sufficient vitamin D intake.\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe comorbidity characteristics of the subjects showed hypertension, arthritis, DM, heart disease, and prostatic hypertrophy as the 5 most common comorbidities among the study subjects. The 2023 Indonesian Health Survey (SKI) stated that hypertension was most common in the age group 65 years and older, at 49.9%.\u003csup\u003e32\u003c/sup\u003e Similarly for other diseases such as DM, heart disease, and stroke.\u003csup\u003e33\u003c/sup\u003e Several studies have reported a relationship between suboptimal vitamin D levels and several comorbidities, such as malignancy, heart disease, DM, infections, autoimmune diseases like rheumatoid arthritis, stroke, chronic obstructive pulmonary disease (COPD), and mental health.\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the inadequacy rate was 53.5%, with a deficiency of 9.3%, insufficiency of 44.2%, and a median of 29.3. Only 46.5% showed adequate vitamin D levels. These results reflect the high burden of hypovitaminosis D in the elderly population at the research sites. In Indonesia, several studies have reported the prevalence of vitamin D inadequacy in the elderly population. A study by Setiati S\u003csup\u003e4\u003c/sup\u003e conducted on 74 elderly women in 4 nursing homes in Jakarta and Bekasi in 2008 showed a vitamin D deficiency prevalence of 35.1%. In 2020, Husna, et al\u003csup\u003e6\u003c/sup\u003e conducted a study in two villages in Pasuruan Regency on 40 elderly patients and found 40% of elderly with insufficiency and 30% with vitamin D deficiency. A study by Vera, et al\u003csup\u003e5\u003c/sup\u003e on 240 women aged 50 years and older in the community showed a vitamin D inadequacy prevalence of 91.7%. A study by Indriyani, et al\u003csup\u003e35\u003c/sup\u003e on 104 geriatric patients at Posyandu lansia Surabaya showed a vitamin D deficiency prevalence of 55.8%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA study by Hidayat, et al\u003csup\u003e36\u003c/sup\u003e on 78 elderly outpatients at the RSCM geriatric polyclinic showed a vitamin D deficiency proportion (\u0026lt;50~nmol/L) of 78.2%. A randomized controlled trial (RCT) by Rizka, et al\u003csup\u003e37\u003c/sup\u003e on 110 geriatric outpatients at the RSCM Geriatric polyclinic showed a vitamin D insufficiency proportion of 85%, in both intervention and placebo groups. Dwimartutie, et al\u003csup\u003e38\u003c/sup\u003e\u0026nbsp; in 2023, found that out of 95 pre-frail elderly outpatients at RSCM, only 11.6% had normal vitamin D levels. Banjuradja, et al\u003csup\u003e7\u003c/sup\u003e found vitamin D deficiency was only 28%, predominantly in the insufficiency group at 33.7%. Recent research in the last few years shows a similar pattern to the results of this study, where insufficiency is greater than deficiency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Shanghai, China, in 2014, among 3,924 community study subjects aged 65-95 years, 43.1% experienced vitamin D deficiency and 38.4% experienced vitamin D insufficiency.\u003csup\u003e14\u003c/sup\u003e A study by Parva, et al\u003csup\u003e39\u003c/sup\u003e on 4,962 adult patients in the United States showed a prevalence of patients with vitamin D levels \u0026lt;50~nmol/L was 39.92%. Kweder, et al\u003csup\u003e27\u003c/sup\u003e conducted research in Europe on elderly subjects in hospitals and found an inadequacy rate of up to 85%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe research results showed a lower deficiency rate and a higher insufficiency rate compared to previous studies. When examining the results of this study, several factors could have influenced it. The results of the vitamin D knowledge questionnaire, although 79.1% did not have overall knowledge, many of the subjects knew about the importance and optimal duration of sun exposure. In addition, most subjects in this study were young elderly, and although most were unemployed, light and vigorous physical activity was frequently found in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Sun Exposure and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLow sun exposure was significantly associated with vitamin D inadequacy in this study (p\u0026lt;0.0001). Research by Kweder, et al\u003csup\u003e27\u003c/sup\u003e states that sun exposure and low physical activity are key factors in the occurrence of vitamin D deficiency in the elderly. A study by Husna, et al\u003csup\u003e6\u003c/sup\u003e on 40 female subjects aged \\ge60 years showed a positive correlation between sun exposure score and serum vitamin D levels (r=0.425; p 0.006). The results of this study reinforce the evidence that UVB exposure is the main factor in vitamin D synthesis in the skin. Wu, et al\u003csup\u003e40\u003c/sup\u003e found that sun exposure can significantly improve vitamin D deficiency status when combined with vitamin D supplementation, which is easier and cheaper in terms of time and cost compared to using vitamin D supplementation alone in the insufficiency group.\u003c/p\u003e\n\u003cp\u003eA study by Setiati, et al\u003csup\u003e4\u003c/sup\u003e on sun exposure in elderly women in Jakarta showed that the highest UV-B light intensity occurred between 11 AM and 1 PM. This study involved diverse ethnic and religious groups, so the body surface area exposed to the sun also influenced the results. Endogenous 25(OH)D synthesis depends on sun exposure, and this is related to latitude.\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Physical Activity and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubjects with sedentary physical activity had the highest risk of vitamin D inadequacy. This may reflect that activity significantly influences vitamin D status. The high proportion of sedentary behaviour in the elderly can contribute to decreased sun exposure and muscle mass. Cheng, et al\u003csup\u003e41\u003c/sup\u003e showed that physical exercise for more than 30 minutes/day had a protective effect against vitamin D deficiency in men, but not in women. In the group with a physical exercise duration of less than 30 minutes per day, as much as 51.88% was significantly associated with vitamin D deficiency. A study by Kluczinsky, et al\u003csup\u003e\u0026nbsp;42\u003c/sup\u003e on 1,343 postmenopausal women showed a positive relationship between vitamin D levels and the duration of outdoor recreational physical activity. Abboud, et al\u003csup\u003e43\u003c/sup\u003e reported that the entry of circulating vitamin D into muscles can increase the half-life of vitamin D in the blood. Physical exercise can also increase the half-life of serum vitamin D. However, Khan, et al\u003csup\u003e44\u003c/sup\u003e in a systematic review and meta-analysis involving all ages, found that physical activity intervention did not independently increase vitamin D levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Vitamin D Knowledge and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKnowledge regarding vitamin D was found to be not significant with vitamin D inadequacy in this study. Many study subjects correctly answered questions about the time and duration of sunbathing. Among all study subjects, only one used sunscreen when going outdoors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn a large study titled \"What Do People Know and Believe about Vitamin D?\" in France involving 60,000 participants, 38% (23,000) of whom were over 55 years old, using a validated questionnaire, found greater awareness and knowledge about vitamin D in this age group. Only 33% of this age group did not know about food sources rich in vitamin D. Interestingly, knowledge about vitamin D did not correlate with vitamin D levels in this study.\u003csup\u003e8,45\u003c/sup\u003e A cross-sectional study in Hong Kong involving 648 elderly subjects aged\u0026nbsp;³65 years found that vitamin D knowledge was mostly related to sun exposure.\u003csup\u003e46\u003c/sup\u003e A study in Korea involving participants over 50 years old, which provided education intervention to increase knowledge about osteoporosis and vitamin D, showed that among 199 participants who completed the full intervention, vitamin D inadequacy decreased from 85% to 66% using a validated questionnaire.\u003csup\u003e47\u003c/sup\u003e The study by Suryadinata, et al\u003csup\u003e\u0026nbsp;26\u003c/sup\u003e in Sidoarjo found a significant relationship between diet and vitamin D knowledge.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Place of Residence and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Indonesia, the proportion of elderly people living in urban and rural areas is almost equal.\u003csup\u003e25\u003c/sup\u003e This study involved 150 subjects from rural areas and 151 from urban areas, and it was found that urban areas had a significant relationship with vitamin D inadequacy. Soontrapa, et al\u003csup\u003e11\u003c/sup\u003e in 2004 assessed the difference in vitamin D levels in elderly women in urban and rural areas and found higher vitamin D levels in rural areas. The same results were found in elderly men in Khon Kaen Province, Thailand.\u003csup\u003e12\u003c/sup\u003e Isidorio, et al\u003csup\u003e13\u003c/sup\u003e studied 25(OH)D levels in urban and rural elderly in Brazil, with an average age of 69 years, and found nearly similar vitamin D levels between urban and rural areas as long as sun exposure was sufficient. Qun, et al\u003csup\u003e14\u003c/sup\u003e found a relationship between vitamin D levels and place of residence (urban or suburban). Elderly people living in suburban areas had a lower prevalence of vitamin D deficiency compared to those living in urban areas. This can be influenced by differences in lifestyle, such as more outdoor activities (higher in suburban communities) and the use of sun protection (higher in urban communities).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResearch subjects living in rural areas had more physical activity compared to those in urban areas. Several prominent factors related to limited physical activity at home in urban areas include the lack of gardening and farming activities around the house. Additionally, urban environments tend to have high building density, with a predominance of indoor activities, thus limiting sun exposure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Comorbidity Index and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA high comorbidity index was found to be unrelated in this study. The variation in comorbidities in this study was not as extensive as in hospital-based studies. Comorbidities in this study were predominantly hypertension. The most common complaint among study subjects was musculoskeletal pain. A study by Neslihan, et al\u003csup\u003e48\u003c/sup\u003e on 685 geriatric patients in Turkey showed a relationship between low vitamin D levels and total comorbidity status in elderly patients. Chen, et al\u003csup\u003e41\u003c/sup\u003e on 1,839 individuals aged 50 years and older in Taiwan showed no significant relationship between CCI score and vitamin D deficiency with an OR of 0.933 (95% CI 0.862-1.009).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Functional Status and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant relationship between functional status and vitamin D inadequacy, but clinically, the trend showed that subjects with dependence had a higher tendency for vitamin D inadequacy. The research subjects included in this study were those without acute illnesses. Some of those with severe and total dependence had residual symptoms from previous illnesses, such as stroke. Boettger, et al\u003csup\u003e49\u003c/sup\u003e showed similar results where functional status, assessed by the Barthel index, did not show a significant relationship with vitamin D deficiency (\u0026lt;20~ng/mL). Montemor, et al\u003csup\u003e50\u003c/sup\u003e who studied vitamin D levels in elderly patients aged \u0026gt;60 years with osteoarthritis, reported that vitamin D deficiency or insufficiency was associated with worse functional status compared to those with normal vitamin D levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Depression and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the depression variable, no significant relationship was found. Okereke, et al\u003csup\u003e51\u003c/sup\u003e wrote an article on the benefits of vitamin D in improving mood and reducing the risk of depression in the elderly, involving a study of 50 subjects and excluding young age. This study found one research that did not find a significant relationship between depression outcomes between the vitamin D and placebo groups. A critical appraisal by Menon, et al\u003csup\u003e52\u003c/sup\u003e stated that vitamin D is inversely related to clinical depression, but still cannot recommend vitamin D supplementation because many other factors cause depression, where one of these causes may also be related to vitamin D.\u003c/p\u003e\n\u003cp\u003eA study by Hoogendijk, et al\u003csup\u003e53\u003c/sup\u003e on 1,282 participants aged 65-95 years found lower vitamin D levels in the group experiencing depression. A study by Vidgren, et al\u003csup\u003e54\u003c/sup\u003e on 1,602 people aged 53-73 years showed a significant relationship between depression and vitamin D deficiency, where as many as 24.1% of patients with depression had vitamin D deficiency. The relationship between vitamin D deficiency and depression is known to be bidirectional. In depressed patients, there can be a decrease in physical activity, sun exposure, and intake, as well as lifestyle changes, all of which are related to vitamin D metabolism in the body. Furthermore, vitamin D deficiency can also be a risk factor for the onset of depression.\u003csup\u003e55\u003c/sup\u003e Longitudinal studies show that elderly patients with vitamin D deficiency are at risk of developing depression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe difference in results in this study may be due to the participants having low comorbidities and disabilities. All subjects with disabilities were accompanied by a caregiver. Some of those with GDS 5\u0026nbsp;³2 results pointed to feelings of boredom and a tendency to go out rather than stay at home.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Cognitive Function and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCognitive impairment was found to be insignificant in this study. Research consistent with this finding includes that by Formiga, et al\u003csup\u003e56\u003c/sup\u003e, although they used subjects older than 85 years. Boettger, et al\u003csup\u003e49\u003c/sup\u003e, using the Mini Mental State Examination (MMSE), also found no significant relationship. These results differ from several previous studies that found a relationship between the two. Various other studies have successfully shown a relationship between vitamin D deficiency and neurodegeneration processes and a decline in cognitive status. In addition to cognitive decline, the effect of vitamin D deficiency on the central nervous system can also result in balance disorders. Low vitamin D levels are significantly found in individuals with Alzheimer's disease, Parkinson's disease, mood disorders, and cognitive decline.\u003csup\u003e16,57\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, this difference may be influenced by the level of education. Several sources of bias, such as language and hearing impairment, were given special attention, such as requiring a caregiver for those with hearing impairment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Nutritional Status and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, nutritional status was assessed using the MNA score. A significant relationship was found in the malnourished group. From this MNA data, obesity was found in 37.87% of subjects. Elderly patients admitted to hospitals or receiving home care showed worse nutritional status compared to elderly individuals in the community. Several studies indicate that 60-80% of hospitalized elderly patients experience malnutrition. This differs from the elderly population in the community, where only 15% experience malnutrition. The prevalence of vitamin D deficiency is quite high in malnourished elderly individuals. A study by Merker, et al\u003csup\u003e58\u003c/sup\u003e on 828 malnourished patients showed a vitamin D deficiency prevalence of 58.2%.\u003c/p\u003e\n\u003cp\u003eA study on the elderly population in South Korea showed that 37% of participants categorized as obese (BMI\u0026nbsp;³25 kg/m\u003csup\u003e2\u003c/sup\u003e) had vitamin D deficiency.\u003csup\u003e59\u003c/sup\u003e The relationship between obesity and vitamin D deficiency is attributed to an inverse relationship between body fat mass and serum vitamin D levels. There is a hypothesis that adipose tissue accumulation can lead to absorption and sequestration of vitamin D, thus reducing the circulating metabolite levels. Other related factors are that obese groups often experience reduced mobilization and physical activity, which in turn reduces sun exposure.\u003csup\u003e60,61\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Sufficiency of Vitamin D Intake and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVitamin D intake in this study was found to be unrelated to vitamin D inadequacy. The lowest intake was 0 unit/day and the highest was 1,155.3 IU/day. Of the 301 study subjects, only 1.33% achieved an intake of 800 IU/day. The presence of vitamin D supplementation, as indicated by the questionnaire, increased the vitamin D intake adequacy rate in the study subjects. Low intake of foods rich in vitamin D, such as fish, meat, milk, and fortified foods, indicates a tendency to reduce high-fat foods, which ultimately leads to vitamin D deficiency.\u003csup\u003e62\u003c/sup\u003e These findings are consistent with Husna, et al\u003csup\u003e6\u003c/sup\u003e, who conducted research in two villages in Wonorejo and Kraton Districts, Pasuruan Regency. Another consistent study was also found by Elizondo-Montemayor, et al.63 in Mexico.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSetiati, Siti\u003csup\u003e4\u003c/sup\u003e found that the average daily vitamin D intake was 0.6 IU. The average daily vitamin D intake in developed countries such as England, Ireland, Denmark, Netherlands, Paris, Germany, Hong Kong, Japan, and Canada is 100-200 IU/day.\u003csup\u003e64\u003c/sup\u003e Cianferotti, et al\u003csup\u003e65\u003c/sup\u003e found that the adequacy of vitamin D intake according to recommendations was still very low, even in high-risk groups for vitamin D deficiency. Kweder, et al\u003csup\u003e27\u003c/sup\u003e found that of all elderly subjects in their study, 90% had not consumed vitamin D supplementation in the past year. Cashman, et al\u003csup\u003e66\u003c/sup\u003e, in their study titled \"Vitamin D deficiency in Europe: Pandemic?\", stated that adequate intake is one of the major challenges in the elderly population, who often experience decreased appetite, economic limitations, or low vitamin D diets.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Medications Consumed and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe variable of medications in this study was found to be unrelated to the incidence of vitamin D inadequacy (p\u0026gt;0.005). In this community study, the most common medication consumed by the subjects was amlodipine. Only 6.98% of the study subjects used medications that could affect vitamin D levels, such as statins. Kweder, et al\u003csup\u003e27\u003c/sup\u003e reported no significant relationship between statin use and vitamin D deficiency. This differs from the results by Sohl, et al\u003csup\u003e67\u003c/sup\u003e, who stated that medications can be a predictor of vitamin D deficiency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Sarcopenia and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, predictive sarcopenia, measured using SARC-F, was found not to be significantly related to vitamin D inadequacy. This finding differs from previous research. Several studies show that vitamin D deficiency is associated with a decrease in both muscle function and strength in the elderly. A study by Visser, et al\u003csup\u003e68\u003c/sup\u003e (Longitudinal Aging Study Amsterdam) showed that compared to groups with sufficient vitamin D levels (\u0026gt;50~nmol/L), groups with low vitamin D levels (25~nmol/L) had a higher risk of sarcopenia (OR 2.57; 95% CI 1.4-4.7) when defined using handgrip strength. From the same study data, Schaap, et al\u003csup\u003e69\u003c/sup\u003e concluded that vitamin D deficiency significantly increases the risk of sarcopenia.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between Frailty and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe condition of frailty is commonly found in a significant number of elderly individuals. In the community-dwelling elderly group, 10.7% of individuals aged 65 years and older have a frail condition. The results of this study showed no significant findings in the multivariate analysis. Buchebner, et al\u003csup\u003e70\u003c/sup\u003e in 2019 found no significant relationship between 25OHD levels and frailty in elderly women aged 85 years. The relationship between vitamin D deficiency and frailty is multifactorial. A meta-analysis by Zhou, et al\u003csup\u003e71\u003c/sup\u003e across 7 studies involving 17,815 individuals showed an increased risk of frailty associated with low vitamin D levels (pooled-OR 1.27; 95% CI 1.17-1.38). Marcos-Perez, et al\u003csup\u003e72\u003c/sup\u003e also found similar results. Vitamin D deficiency is associated with an increased risk of falls, increased inflammatory processes, and decreased muscle strength and physical performance. Additionally, frailty can also lead to decreased vitamin D levels due to reduced outdoor physical activity and sun exposure.\u003csup\u003e71\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between History of Falls in the Last Year and Vitamin D Inadequacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA history of falls was significantly associated with vitamin D inadequacy. The prevalence of vitamin D insufficiency was found to be higher in the elderly group with a history of falls compared to the group without a history of falls (70% vs 40%).\u003csup\u003e73\u003c/sup\u003e A study by Bischoff-Ferrari, et al\u003csup\u003e74\u003c/sup\u003e showed a significant relationship between vitamin D levels\u0026nbsp;£12ng/mL and thigh muscle extension strength. A study by Annweiler, et al\u003csup\u003e75\u003c/sup\u003e showed a significant relationship between low vitamin D levels and low quadriceps muscle strength and handgrip strength. Individuals with low vitamin D levels tend to have poor body balance and neuromuscular function, thereby increasing the risk of falls.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several strengths supported by internal and external validity, as well as the clinical relevance of the obtained results. The research topic is an important and current issue, especially regarding local data on vitamin D status, which is still limited in South Sulawesi. This study also provides significant scientific contributions to the development of regional epidemiological data related to vitamin D inadequacy in Eastern Indonesia. The sufficiently large number of subjects provided good statistical power in both bivariate and multivariate analyses. Vitamin D level measurements were performed in a standardized laboratory, which increased data validity and reduced potential measurement bias. The multidimensional approach used in this study allowed for comprehensive data analysis of various determinants affecting vitamin D status. The use of multivariate analysis with several logistic regression models strengthened the conclusions regarding the main determinants of vitamin D inadequacy. Based on the literature review, this study is the first in Indonesia to include urban/rural variables and vitamin D knowledge linked to vitamin D inadequacy in the elderly community. This study is also the first in East Luwu Regency and Makassar City to assess vitamin D inadequacy with a comprehensive geriatric assessment.\u003c/p\u003e\n\u003cp\u003eHowever, this study also has limitations, namely the cross-sectional design used does not allow the researchers to conclude causal relationships. Recall bias may also occur in this study, especially for questionnaires on sun exposure, physical activity, and frequency of vitamin D nutrient intake. In this study, low sun exposure was found to be highly influential on the incidence of inadequacy, but this study did not measure the intensity and wavelength of UV light.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e\u0026nbsp;* The prevalence of vitamin D inadequacy in the elderly population of South Sulawesi is 53.5%, with insufficiency at 44.2% and deficiency at 9.3%.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;* Low sun exposure, sedentary physical activity, urban residence, and a history of falls are associated with vitamin D inadequacy in the elderly population of South Sulawesi.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that we have no competing interests. There is no funder for this research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eIsman, Haniyyah -- Prepared the main concept, took the data, analyzed and interpreted dataDwimartutie, N -- Prepared the main concept and interpreted dataSetiati, S -- Prepared the main concept and interpreted dataNugroho, P -- Prepared the main concept and interpreted data\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAspell N, Laird E, Healy M, Shannon T, Lawlor B, O\u0026rsquo;Sullivan M. The prevalence and determinants of vitamin D status in community-dwelling older adults: Results from the English Longitudinal Study of Ageing (ELSA). \u003cem\u003eNutrients\u003c/em\u003e. 2019;11(6):1253.\u003c/li\u003e\n\u003cli\u003eHye YJ, Mu YK, Jung MK, Do WK, Chae BK. Vitamin D deficiency in nursing home elderly in Korea. \u003cem\u003eAnn Geriatr Med Res\u003c/em\u003e. 2016;20(2):102-107.\u003c/li\u003e\n\u003cli\u003eRonaldson A, Arias de la Torre J, Gaughran F, et al. Prospective Associations between Vitamin D and Depression in Middle-Aged Adults: Findings from the UK Biobank Cohort. \u003cem\u003ePsychol Med\u003c/em\u003e. 2022;52(10):1866-1874.\u003c/li\u003e\n\u003cli\u003eSetiati S. Vitamin D Status Among Indonesia Elderly Women Living in Instutionalized Care Units. \u003cem\u003eActa Med Indones\u003c/em\u003e. 2008;40(2):78-83.\u003c/li\u003e\n\u003cli\u003eVera V, Setiati S, Govinda A. Determinan Diagnostik Klinis Defisiensi Vitamin D pada Wanita Berusia Lebih dari 50 Tahun. \u003cem\u003eJ Penyakit Dalam Indones\u003c/em\u003e. 2015;2(1).\u003c/li\u003e\n\u003cli\u003eHusna K, Widajanti N, Sumarmi S, Firdausi H. Hubungan antara Skor Paparan Matahari dan Asupan Vitamin D dengan Kadar 25 (OH)D Serum pada Wanita Usia Lanjut. \u003cem\u003eJ Penyakit Dalam Indones\u003c/em\u003e. 2021;8(2):63-71.\u003c/li\u003e\n\u003cli\u003eBanjuradia I, Dwimartutie N, Purnamasari D, Harimurti K. \u003cem\u003ePrevalence and Diagnostic Determinants of Vitamin D Deficiency in Outpatient Elderly Patients\u003c/em\u003e. Indonesia University; 2023.\u003c/li\u003e\n\u003cli\u003eDeschasaux M, Souberbielle JC, Partula V, et al. What Do People Know and Believe about Vitamin D. \u003cem\u003eNutrients\u003c/em\u003e. 2016;8(11):1-15.\u003c/li\u003e\n\u003cli\u003eLee H, Kim KN, Lim YH, Hong YC. Interaction of Vitamin D and Smoking on Inflammatory Markers in the Urban Elderly. \u003cem\u003ePrev Med Public Health\u003c/em\u003e. 2015;48(5):249-256.\u003c/li\u003e\n\u003cli\u003eHeriyana A, Pazanuddin AF, Rosiadi A, et al. \u003cem\u003ePeraturan Kepala Badan Pusat Statistik Nomor 120 Tahun 2020 Tentang Klasifikasi Desa Perkotaan Dan Perdesaan Di Indonesia 2020 Buku 2 Jawa\u003c/em\u003e.; 2021.\u003c/li\u003e\n\u003cli\u003eSoontrapa S, Soontrapa S, Chailurkit LO. The Difference in Vitamin D Status between Urban and Rural Elderly Women of Khon Kaen Province, Thailand. \u003cem\u003eSrinagarind Med J\u003c/em\u003e. 2004;19(2):67-74.\u003c/li\u003e\n\u003cli\u003eSoontrapa S, Soontrapa S, Chaikitpinyo S. Prevalence of Vitamin D Insufficiency among Elderly Males Living in Rural Khon Kaen Province, Northeast Thailand. \u003cem\u003eJ Med Assoc Thai\u003c/em\u003e. 2015;98(8):S21-S25.\u003c/li\u003e\n\u003cli\u003eIsidorio U de A, Vilar de Assis E, Lacerda SNB, et al. Relationship between Lifestyle and Residence Area with 25(OH)D Levels in Older Adults. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e. 2023;20(1):1-11.\u003c/li\u003e\n\u003cli\u003eQun C, Yanping D, Wei H, et al. Factors associated to serum 25 - hydroxyvitamin D levels among older adult populations in urban and suburban communities in Shanghai, china. \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2017;17(246):1-10.\u003c/li\u003e\n\u003cli\u003eBruyere O, Cavalier E, Souberbielle JC, et al. Effects of Vitamin D in the Elderly Population: Current Status and Perspectives. \u003cem\u003eArch Public Health\u003c/em\u003e. 2014;72(1):1-10.\u003c/li\u003e\n\u003cli\u003eUchitomi R, Oyabu M, Kamei Y. Vitamin D and Sarcopenia: Potential of Vitamin D Supplementation in Sarcopenia Prevention and Treatment. \u003cem\u003eNutrients\u003c/em\u003e. 2020;12(3189):1-12.\u003c/li\u003e\n\u003cli\u003eJianghua Z, Pan H, Ping L, et al. Association of Vitamin D Deficiency and Frailty: A Systematic Review and Meta - Analysis. \u003cem\u003eMaturitas\u003c/em\u003e. 2016;94:70-76.\u003c/li\u003e\n\u003cli\u003eSultan S, Taimuri U, Basnan SA, et al. Low Vitamin D and Its Association with Cognitive Impairment and Dementia. \u003cem\u003eJ Aging Res\u003c/em\u003e. Published online April 30, 2020:1-10.\u003c/li\u003e\n\u003cli\u003eGrober U. Common Drugs as Vitamin D Disruptor. \u003cem\u003eJ Transl Sci\u003c/em\u003e. 2020;6:1-4.\u003c/li\u003e\n\u003cli\u003eAl-Daghri NM, Aljohani N, Al - Attas OS, et al. Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults. \u003cem\u003eInt J Clin Exp Pathol\u003c/em\u003e. 2015;8(7):8480-8486.\u003c/li\u003e\n\u003cli\u003eBadan Pusat Statistik Kota Makassar. \u003cem\u003eKota Makassar Dalam Angka 2024\u003c/em\u003e.; 2024.\u003c/li\u003e\n\u003cli\u003eBadan Pusat Statistik. \u003cem\u003eKabupaten Luwu Timur Dalam Angka 2024\u003c/em\u003e.; 2024.\u003c/li\u003e\n\u003cli\u003eBadan Pusat Statistik Kota Makassar. \u003cem\u003eKecamatan Tamalanrea Dalam Angka 2024\u003c/em\u003e.; 2024.\u003c/li\u003e\n\u003cli\u003eBadan Pusat Statistik Kabupaten Luwu Timur. \u003cem\u003eKecamatan Burau Dalam Angka\u003c/em\u003e.; 2024.\u003c/li\u003e\n\u003cli\u003eBadan Pusat Statistik. \u003cem\u003eStatistik Penduduk Lanjut Usia 2024\u003c/em\u003e.; 2024.\u003c/li\u003e\n\u003cli\u003eSuryadinata RV, Lorensia A. Food Frequency, Knowledge about Vitamin D and Obesity among Elderly. \u003cem\u003eAmerta Nutr\u003c/em\u003e. Published online 2020:43-48.\u003c/li\u003e\n\u003cli\u003eKweder H, Eldi H. Vitamin D Deficiency in Elderly: Risk Factors and Drugs Impact on Vitamin D Status. \u003cem\u003eAvicenna J Med\u003c/em\u003e. 2018;2018(8):139-146.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eWorld Health Statistics 2025: Monitoring Health for the SDGs, Sustainable Development Goals.\u003c/em\u003e; 2025.\u003c/li\u003e\n\u003cli\u003eAclan R, Deoge S, Block H, Lane R, Laver K. Middle Aged and Older Adult\u0026rsquo;s Perspectives of Their Own Home Environment: A Review of Qualitative Studies and Meta-Synthesis. \u003cem\u003eBMC Geriatrics volume\u003c/em\u003e. 2023;23.\u003c/li\u003e\n\u003cli\u003eChu WM, Ho HE, Yeh CJ, Tsan YT, Lee SH, Lee MC. Late-career unemployment and risk of frailty among older adults in Taiwan: An 8-year population-based cohort study. \u003cem\u003eGeriatr Gerontol Int \u003c/em\u003e. 2021;21(4):353-358.\u003c/li\u003e\n\u003cli\u003eGriffin TP, Wall D, Blake L, et al. Higher Risk of Vitamin D Insufficiency/Deficiency for Rural than Urban Dwellers. \u003cem\u003eJ Steroid Biochem Mol Biol\u003c/em\u003e. Published online 2020.\u003c/li\u003e\n\u003cli\u003eKementerian Kesehatan Republik Indonesia. \u003cem\u003eSurvei Kesehatan Indonesia (SKI) 2023 Dalam Angka\u003c/em\u003e.; 2023.\u003c/li\u003e\n\u003cli\u003ePusat Data dan Teknologi Informasi Kementerian Kesehatan RI. \u003cem\u003eInfodatin: Lansia Berdaya, Bangsa Sejahtera\u003c/em\u003e.; 2022.\u003c/li\u003e\n\u003cli\u003eCahyawati WASN, Yasmina A, Suarjana IN, Rudiansyah M, Henry J. Correlation Between Vitamin D Levels and Charlson Comorbidity Index with Sarcopenia in Geriatric Patients. \u003cem\u003eSEEJPH\u003c/em\u003e. 2024;25:901-907.\u003c/li\u003e\n\u003cli\u003eIndrayani HW, Widajanti N, Firdausi H. The Relationship Between Serum Calcidiol Deficiency and the Degree of Sarcopenia in Elderly Communities in Surabaya. \u003cem\u003eJ penyakit dalam Indones\u003c/em\u003e. 2020;7(1):29-33.\u003c/li\u003e\n\u003cli\u003eHidayat R, Setaiti S, Soeondo Pradana. The Association Between Vitamin D Deficiency and Type 2 Diabetes Mellitus in Elderly Patients. \u003cem\u003eActa Med Indones\u003c/em\u003e. 2010;42(3):123-129.\u003c/li\u003e\n\u003cli\u003eRizka A, Setiati S, Harimurti K, Sadikin M, Mansur IG. Effect of Alfacalcidol on Inflammatory Markers and T Cell Subsets in Elderly with Frailty Syndrome: A Double Blind Randomized Controlled Trial . \u003cem\u003eActa med Indones\u003c/em\u003e. 2018;50(3):215-221.\u003c/li\u003e\n\u003cli\u003eDwimartutie N, Setiati S, Tamin TZ, et al. Vitamin D levels in pre-frail older adults and its correlation with hand grip strength. \u003cem\u003eActa Med Indones\u003c/em\u003e. 2023;55(2):172-179.\u003c/li\u003e\n\u003cli\u003eParva NR, Tadepalli S, Singh P, et al. Prevalence of Vitamin D Deficiency and Associated Risk Factors in the US Population (2011 - 2012). \u003cem\u003eCureus\u003c/em\u003e. 2018;10(6):1-10.\u003c/li\u003e\n\u003cli\u003eWu SE, Chen WL. Moderate Sun Exsposure Is the Complementor in Isufficient Vitamin D Consumer. \u003cem\u003eFrontNutr\u003c/em\u003e. 2022;9:1-11.\u003c/li\u003e\n\u003cli\u003eQun C, Yanping D, Wei H, et al. Factors Associated to Serum 25-Hydroxyvitamin D Levels among Older Adult Populations in Urban and Suburban Communities in Shanghai, China. \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2017;17(246):1-10.\u003c/li\u003e\n\u003cli\u003eKluczynski MA, Lamonte MJ, Mares JA, et al. Duration of Physical Activity and Serum 25 - Hydroxyvitamin D Status of Postmenopousal Women. \u003cem\u003eAnn Epidemiol\u003c/em\u003e. 2011;21(6):440-449.\u003c/li\u003e\n\u003cli\u003eAbboud M, Puglisi DA, Davies BN, et al. Evidence for a Specific Uptake and Retention Mechanism for 25 - Hydroxyvitamin D (25OHD) in Skeletal Muscle Cells. \u003cem\u003eEndocrinology\u003c/em\u003e. 2013;154(9):3022-3030.\u003c/li\u003e\n\u003cli\u003eKhan SR, Claeson M, Khan A, Neale RE. The Effect of Physical Activity on Vitamin D: A Systematic Review and Meta-Analysis of Intervention Studies in Humans. \u003cem\u003ePublic Health Res Pract\u003c/em\u003e. 2024;7.\u003c/li\u003e\n\u003cli\u003eOudshoorn C, Hartholt KA, PTM van Leeuwen J, Colin EM, Velde N van der, Cammen TJ van der. Better Knowledge on Vitamin D and Calcium in Older People is Associated with A Higher Serum Vitamin D Level and A Higher Daily Dietary Calcium Intake. \u003cem\u003eHealth Educ J\u003c/em\u003e. 2012;71(4):474-482.\u003c/li\u003e\n\u003cli\u003eChristides T. Older Adults\u0026rsquo;s Beliefs, Knowledge and Preferences for Achieving Healthy Vitamin D Status: A Narrative Review. \u003cem\u003eGeraitrics\u003c/em\u003e. 2018;3(26):1-17.\u003c/li\u003e\n\u003cli\u003eKi-Soo P, Jun-II Y, Ha-Young K, Sunmee J, Yongsoon P, Yong-Chan H. Education and Exercise Program Improves Osteoporosis Knowledge and Changes Calcium and Vitamin D Dietary Intake in community Dwelling Elderly. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2017;17(966):1-8.\u003c/li\u003e\n\u003cli\u003eGokcen N, Benlidayi IC, Kocaer A, Basaran S. Association Between VItamin D Level and Total Comorbidity Status in Geriatric Patients. \u003cem\u003eTurk J Geriatr\u003c/em\u003e. 2018;21(4):536-543.\u003c/li\u003e\n\u003cli\u003eBoettger S, Angersbach B, Klimek C, Wanderley A, Shaibekov A, Sieske L. Prevalence and Predictors of Vitamin D-Deficiency in Frail Older Hospitalized Patients. \u003cem\u003eBMC Geriatr \u003c/em\u003e. 2018;18:1-6.\u003c/li\u003e\n\u003cli\u003eMontemor CN, Fernandes MTP, Marquez AS, Poli - Frederico RC, Alexandre da Silva R, Fernandes KB. Vitamin D Deficiency, Functional Status, and Balance in Older Adults with Osteoarthritis. \u003cem\u003eWorld J Clin Cases\u003c/em\u003e. 2021;9(31):9491-9499.\u003c/li\u003e\n\u003cli\u003eOkereke OI, Singh A. The Role of Vitamin D in the Prevention of Late Life Depression. \u003cem\u003eJ Affect Disord\u003c/em\u003e. 2016;198:1-14.\u003c/li\u003e\n\u003cli\u003eMenon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. \u003cem\u003eIndianJPsycholMed\u003c/em\u003e. 2020;42(1).\u003c/li\u003e\n\u003cli\u003eHoogendijk WJG, Lips P, Dik MG, Deeg DJH, Baekman ATF, Pennix BWJH. Depression Is Associated with Decreased 25-Hydroxyvitamin D and Increased Parathyroid Hormone Levels in Older Adults. \u003cem\u003eArch Gen Psychiatry\u003c/em\u003e. 2008;65(5):508-512.\u003c/li\u003e\n\u003cli\u003eVidgren M, Virtanen JK, Tolmunen T, et al. Serum Concentrations of 25-Hydroxyvitamin D and Depression in A General Middle-Aged to Elderly Population in Finland. \u003cem\u003eJ Nutr Health Aging\u003c/em\u003e. 2018;22(1):159-164.\u003c/li\u003e\n\u003cli\u003eOliveira C de, Hirani V, Biddulph JP. Associations Between Vitamin D Levels and Depressive Symptoms in Later Life: Evidence from the English Longitudinal Study of Ageing (ELSA). \u003cem\u003eJ Gerontol A Biol Sci Med Sci\u003c/em\u003e. 2018;73(10):1377-1382.\u003c/li\u003e\n\u003cli\u003eFormiga F, Ferrer A, Almeda J, San Jose A, Gil A, Pujol R. Utility of Geriatric Assessment Tools to Identify 85-Years Old Subjects with Vitamin D Deficiency. \u003cem\u003eJ Nutr Health Aging\u003c/em\u003e. 2011;15:110-114.\u003c/li\u003e\n\u003cli\u003eKupisz-Urbańska M, Łukaszkiewicz J, Marcinowska-Suchowierska. Vitamin D in Elderly. \u003cem\u003eIntechOpen\u003c/em\u003e. Published online 2021:1-15.\u003c/li\u003e\n\u003cli\u003eMerker M, Amsler A, Pereira R, et al. Vitamin D Deficiency is Highly Prevalent in Malnourished Inpatients and Associated with Higher Mortality. \u003cem\u003eMedicine\u003c/em\u003e. 2019;98(48):1-9.\u003c/li\u003e\n\u003cli\u003eSun HK, Jung EO, Dong WS, et al. The Factors Associated with Vitamin D Deficiency in Community Dwelling Elderly in Korea. \u003cem\u003eNutr Res Pract\u003c/em\u003e. 2018;12(5):387-395.\u003c/li\u003e\n\u003cli\u003eHolick MF, Binkley NC, Bischoff-Ferrai HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guidline. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e. 2011;96(7):1911-1930.\u003c/li\u003e\n\u003cli\u003eAmerican Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations Abstracted from the American Geriatrics Society Consensus Statement on Vitamin D for Prevention of Falls and Their Consequences. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e. 2014;62(1):147-152.\u003c/li\u003e\n\u003cli\u003eRimahardika R, Subagio HW, Wijayanti HS. Asupan Vitamin D Dan Paparan Sinar Matahari Pada Orang Yang Bekerja Di Dalam Ruangan Dan Di Luar Ruangan. \u003cem\u003eJournal of Nutrition College\u003c/em\u003e. 2017;6(4):333. doi:10.14710/jnc.v6i4.18785\u003c/li\u003e\n\u003cli\u003eElizondo-Montemayor L, Castillo E, Rodriguez-Lopez C, Vialrreal-Calderon J, Gomez-Carmona M, Tenorio-Martinez S. Seasonal Variation in Vitamin D in Association with Age, Inflammatory Cytokines, Anthropometric Parameters, and Lifestyle Factos in Older Adults. \u003cem\u003eMediat of inflam\u003c/em\u003e. Published online 2017.\u003c/li\u003e\n\u003cli\u003eLips P. Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications. \u003cem\u003eEndocr Rev\u003c/em\u003e. 2001;22(4):477-501.\u003c/li\u003e\n\u003cli\u003eCianferotti L, Parri S, Civinini R, Brandi ML. The Use of Cholecalciferol in Patients with Hip Fracture. \u003cem\u003eClin Cases Miner Bone Metab\u003c/em\u003e. 2017;14(1):48-53.\u003c/li\u003e\n\u003cli\u003eCashman KD, Dowling KG, \u0026Scaron;krab\u0026aacute;kov\u0026aacute; Z, et al. Vitamin D Deficiency in Europe: Pandemic? \u003cem\u003eAm J Clin Nutr \u003c/em\u003e. 2016;103(4):1033-1044.\u003c/li\u003e\n\u003cli\u003eSohl E, M. van Schoor N, T de Jongh R, Visser M, Deeg DJP, Lips P. Vitamin D Status Is Associated With Functional Limitations and Functional Decline in Older Individuals. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e. 2013;98(9):1483-1490.\u003c/li\u003e\n\u003cli\u003eVisser M, Deeg DJ, 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. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e. 2003;88(12):5766-5772.\u003c/li\u003e\n\u003cli\u003eSchaap LA, M van Schoor N, Lips P, Visser M. Associations of Sarcopenia Definitions, and Their Components, with the Incidence of Recurrent Falling and Fractures: the Longitudinal Aging Study Amsterdam. \u003cem\u003eJ Gerontol A Biol Sci Med Sci\u003c/em\u003e. 2018;73(9):1199-1204.\u003c/li\u003e\n\u003cli\u003eBuchebner D, Bartosch P, Malmgren L, McGuigan FE, Gerdhem P, Akesson KE. Association Between Vitamin D, Frailty, and Progression of Frailty in Community - Dwelling Older Women. \u003cem\u003eJ Clin Endocrinol Metab\u003c/em\u003e. 2019;104(12):6139-6147.\u003c/li\u003e\n\u003cli\u003eZhou J, Huang P, Liu P, et al. Association of Vitamin D Deficiency and Frailty: A Systematic Review and Meta - Analysis. \u003cem\u003eMaturitas\u003c/em\u003e. 2016;94:70-76.\u003c/li\u003e\n\u003cli\u003eMarcos-Perez D, Sanchez-Flores M, Proietti S, et al. Low Vitamin D Levels and Frailty Status in Older Adults: A Systematic Review and Meta-Analysis. \u003cem\u003eNutrients\u003c/em\u003e. 2020;12(8):1-20.\u003c/li\u003e\n\u003cli\u003eAnnweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O. Fall Prevention and Vitamin D in the Elderly: An Overview of the Key ROle of the non-Bone Effects. \u003cem\u003eJ Neuroneng Rehabil\u003c/em\u003e. 2010;7(50):1-13.\u003c/li\u003e\n\u003cli\u003eBischoff H, Stahelin H, Urscheler N, et al. Muscle Strength in the Elderly: Its Relation to Vitamin D Metabolites. \u003cem\u003eArch Phys Med Rehabil\u003c/em\u003e. 1999;80(1):54-58.\u003c/li\u003e\n\u003cli\u003eAnnweiler C, Schott-Petelaz AM, Berrut G, et al. Vitamin D deficiency-realted Quadriceps Weakness: Results of the Epidemiologie De l\u0026rsquo;Osteoporose Cohort. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e. 2009;57(2):368-369.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vitamin D inadequacy, elderly, South Sulawesi","lastPublishedDoi":"10.21203/rs.3.rs-7024040/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7024040/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Vitamin D inadequacy remains a health issue in elderly population of Indonesia. Vitamin D has skeletal and non-skeletal effects, that can improve elderly quality of life. Various factors associated with inadequate vitamin D levels are observed in this study. \u0026nbsp; Objective: To determine the prevalence and factors associated with vitamin D inadequacy in the elderly population of South Sulawesi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis was a cross-sectional study using multistage cluster random sampling conducted in Makassar City and East Luwu Regency, South Sulawesi Province, from December 2024 to May 2025. Sociodemographic data and risk factors were collected using questionnaire and Serum vitamin D levels were measured using the Chemiluminescent Microparticle Immunoassay (CMIA) method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 301 subjects met the inclusion and exclusion criteria, with median age 68 (64 – 73) years old and mainly female (62,79%).The prevalence of Vitamin D inadequacy is 53,5%. Multivariate test showed \u0026nbsp;low sun exposure [PR: 2,226\u0026nbsp; 95%\u0026nbsp; CI (1,731 – 2,862)], sedentary physical activity [ PR: 1,548 95% CI (1,159 – 2,067)], live in urban area [PR: 1,356 95% CI (1,083 – 1,697)], fall history [PR: 1,257 95% CI (1,047 – 1,553)] are variables associated with vitamin D inadequacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The prevalence of vitamin D inadequacy in the elderly population of South Sulawesi is 53.5%. Factors associated with vitamin D inadequacy are low sun exposure, sedentary physical activity, live in urban area, and fall history. \u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Prevalence and Factors Associated with Vitamin D Inadequacy in the Elderly Population of South Sulawesi","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-03 06:00:00","doi":"10.21203/rs.3.rs-7024040/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"676e9040-dc0c-4eb8-9a96-1c181bf4a593","owner":[],"postedDate":"July 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T12:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-03 06:00:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7024040","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7024040","identity":"rs-7024040","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}