{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:34:44Z","timestamp":1790786084841,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Executive dysfunction is common in adults with hypertension and undermines self-management. Low 25-hydroxyvitamin D [25(OH)D] and elevated homocysteine may damage the endothelium and white matter, while their non-linear dose\u2013response and joint effects on executive dysfunction are unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center, prospective, cross-sectional study of inpatients aged \u226560\u202fyears with hypertension (November 2023\u2013July 2024). Exposures were vitamin D deficiency [25(OH)D\u202f&amp;lt;\u202f20\u202fng\/mL] and hyperhomocysteinemia (hymocysteine \u226515\u202f\u03bcmol\/L), combined into a four-level dual-risk variable. Executive function was a composite of four tests. Non-linear associations were estimated with logistic regression using restricted cubic splines. Multiplicative interaction was assessed after adjustment for demographic, clinical, renal, lifestyle, supplementation, and seasonal covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 498 individuals screened, 452 participants were analyzed. Vitamin D deficiency was observed in 49% participants, with hyperhomocysteinemia in 34%, dual-risk in 22%, and executive dysfunction in 38% participants. Non-linear associations were evident for both biomarkers (\n                      <jats:italic>p<\/jats:italic>\n                      _non-linear \u22640.04). Adjusted odds of executive dysfunction were 1.61 (95% CI 1.2\u20132.2) at 25(OH)D\u202f=\u202f15 vs. 30\u202fng\/mL and 1.4 (1.1\u20132.0) at homocysteine 18 vs. 10\u202f\u03bcmol\/L. Relative to neither risk, dual-risk had OR 2.1 (1.5\u20132.9) with multiplicative interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03) and additive synergy (excess risk due to interaction 0.45, 95% CI 0.06\u20130.95).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In older hypertensive inpatients, lower 25(OH)D and higher homocysteine are non-linearly associated with executive dysfunction, and co-occurrence confers excess risk beyond individual effects. Assessing both biomarkers may enhance risk stratification and guide trials of combined correction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1718923","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T05:21:41Z","timestamp":1768540901000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of serum 25-hydroxyvitamin D and homocysteine \u201cdouble-risk\u201d status with executive dysfunction in older adults with hypertension"],"prefix":"10.3389","volume":"12","author":[{"given":"Lili","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Geriatrics, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linya","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinyin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Affiliated Hospital of Hebei University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1017\/9781108942751.014","article-title":"Hypertension","volume-title":"Reichel\u2019s care of the elderly: clinical aspects of aging","author":"Zamora","year":"2022"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1038\/S41581-021-00430-6","article-title":"Hypertension-induced cognitive impairment: from pathophysiology to public health","volume":"17","author":"Ungvari","year":"2021","journal-title":"Nat Rev Nephrol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"225","DOI":"10.12701\/jyms.2022.00605","article-title":"Hypertension and cognitive dysfunction: a narrative review","volume":"40","author":"Cheon","year":"2023","journal-title":"J Yeungnam Med 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