Lower Dietary and Circulating Vitamin C in Middle- and Older-Aged Men and Women Are Associated with Lower Estimated Skeletal Muscle Mass

Abstract

Background Age-related loss of skeletal muscle mass contributes to poor outcomes including sarcopenia, physical disability, frailty, type 2 diabetes, and mortality. Vitamin C has physiological relevance to skeletal muscle and may protect it during aging, but few studies have investigated its importance in older populations. Objectives We aimed to investigate cross-sectional associations of dietary and plasma vitamin C with proxy measures of skeletal muscle mass in a large cohort of middle- and older-aged individuals. Methods We analyzed data from >13,000 men and women in the European Prospective Investigation into Cancer and Nutrition–Norfolk cohort, aged 42–82 y. Fat-free mass (FFM), as a proxy for skeletal muscle mass, was estimated using bioelectrical impedance analysis and expressed as a percentage of total mass (FFM%) or standardized by BMI (FFMBMI). Dietary vitamin C intakes were calculated from 7-d food diary data, and plasma vitamin C was measured in peripheral blood. Multivariable regression models, including relevant lifestyle, dietary, and biological covariates, were used to determine associations between FFM measures and quintiles of dietary vitamin C or insufficient compared with sufficient plasma vitamin C (<50 μmol/L and ≥50 μmol/L). Results Positive trends were found across quintiles of dietary vitamin C and FFM measures for both sexes, with interquintile differences in FFM% and FFMBMI of 1.0% and 2.3% for men and 1.9% and 2.9% for women, respectively (all P < 0.001). Similarly, FFM% and FFMBMI measures were higher in participants with sufficient than with insufficient plasma vitamin C: by 1.6% and 2.0% in men, and 3.4% and 3.9% in women, respectively (all P < 0.001). Associations were also evident in analyses stratified into <65-y and ≥65-y age groups. Conclusions Our findings of positive associations, of both dietary and circulating vitamin C with measures of skeletal muscle mass in middle- and older-aged men and women, suggest that dietary vitamin C intake may be useful for reducing age-related muscle loss.

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“…Vitamin C is required for collagen crosslinking; thus, its low intake or deficiency could lead to a weakening of the collagenous structure in bone and to other impairments related to a low antioxidant intake [ 9 , 10 , 11 , 12 , 64 ]. In a recent study, Lewis et al reported a positive correlation between dietary and circulating levels of vitamin C and muscle mass in older men and women [ 74 ]. As vitamin C is a strong antioxidant and is involved in immune system regulation, its inadequate intake may lead to an increased risk of infections, particularly relevant in the COVID-19 era [ 10 ].…”

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“…In addition, vitamin C is involved in the synthesis of carnitine and collagen [ 48 ]. While carnitine is required for the metabolism of long chain fatty acids during physical activity, collagen is a key structural component of skeletal muscles and tendons [ 49 , 50 ].…”

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