FOOD SOURCES OF VITAMIN D AND ITS DEFICIENCY IN WORKER WOMEN

Abstract

The main source of vitamin D comes from sunlight. The high vitamin D deficiency is strongly associated with low sun exposure. The sources of vitamin D in food was limited. This study is to identify food sources and food habits of female factory workers. This study used a cross sectional design and was conducted at PT Gunung Salak (garment factory) in Sukabumi, Indonesia. Sample population was female workers at child bearing age (18-40 years old) who works in garment factory, 154 women. The data collected in this study was primary type. The primary data was collected through interviews using a questionnaire and analysis of blood biochemistry (serum 25(OH)D). Vitamin D status analysis was performed by taking blood through the vein by laboratory analyst. Data of repondents' characteristics (name, date of birth, ethnic group, and education), food sources and food habits were collected by questionnaire. The finding obtained the respondents' average consumption of chicken eggs was 20.1 times per month with an average weight per consumption as much as 56.3 g. Chicken eggs were a food stuff which was consumed most frequently by the respondents. The kinds of fruits and vegetables containing vitamin D were very few and rarely consumed by the respondents. However, the respondents' fruit consumption was high enough for each consumption. The kinds of fruits which were most frequently consumed by the respondents were oranges, bananas, and papayas. The vegetable which was consumed most frequently was spinach. Spinach was consumed for 6.0 per month with the average weight of 55.6 g for each consumption.

Full text

4th Asian Academic Society International Conference (AASIC) 2016
Globalizing Asia: Integrating Science, Technology and Humanities for Future Growth and Development
233
HEA-OR-082
FOOD SOURCES OF VITAMIN D AND ITS DEFICIENCY IN WORKER WOMEN
Betty Yosephin1, Faisal Anwar2, Hadi Riyadi2, Ali Khomsan2, Nur Elly1
1Nutrition Department of Health Polytechnique, the Indonesian Ministry of Health Bengkulu,
Bengkulu, 38224, Indonesia
2Department of Community Nutrition, the Faculty of Human Ecology, Bogor Agricultural
University, Bogor, 16680, Indonesia
Corresponding author‘s email: patricknmom@yahoo.co.id
The main source of vitamin D comes from sunlight. The high vitamin D deficiency is strongly
associated with low sun exposure. The sources of vitamin D in food was limited. This study is to
identify food sources and food habits of female factory workers. This study used a cross sectional
design and was conducted at PT Gunung Salak (garment factory) in Sukabumi, Indonesia. Sample
population was female workers at child bearing age (18-40 years old) who works in garment
factory, 154 women. The data collected in this study was primary type. The primary data was
collected through interviews using a questionnaire and analysis of blood biochemistry (serum
25(OH)D). Vitamin D status analysis was performed by taking blood through the vein by laboratory
analyst. Data of repondents‘ characteristics (name, date of birth, ethnic group, and education), food
sources and food habits were collected by questionnaire. The finding obtained the respondents‘
average consumption of chicken eggs was 20.1 times per month with an average weight per
consumption as much as 56.3 g. Chicken eggs were a food stuff which was consumed most
frequently by the respondents. The kinds of fruits and vegetables containing vitamin D were very
few and rarely consumed by the respondents. However, the respondents‘ fruit consumption was
high enough for each consumption. The kinds of fruits which were most frequently consumed by
the respondents were oranges, bananas, and papayas. The vegetable which was consumed most
frequently was spinach. Spinach was consumed for 6.0 per month with the average weight of 55.6 g
for each consumption.
Keywords: Food Sources, Worker Women, Vitamin D
1. INTRODUCTION
Worker women are a part of women of childbearing age who need to get attention because
those women are rarely exposed to sunlight. This is connected with their working hours which start
in the morning and end in the evening, and they work indoor so they are likely to be at risk of
vitamin D deficiency coming from sunlight.
Vitamin D is solulable in the fat which consists of steroid molecular structures. Vitamin D is
not merely as vitamin because it can be synthesized by the body with the help of sunlight exposure.
Naturally vitamin D is found in fish oil, egg, margarine, liver, some fish such: mackerel, salmon,
sardine, and tuna. Now there are many kinds of foods which contain fortified vitamin D,
particularly milk products, biscuits, and cereals. Vegetable foods generally contain low vitamin D
(Kauffman 2009). The more frequently one consumes foods containing high vitamin D, the more
his/her requirement of vitamin D is likely to be fulfilled.

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Several factors that are predicted to lead to high deficiency of vitamin D are; (1) low intake
of food containing vitamin D such as milk and fortified food, (2) the tendency of reducing food high
in fat, which is in turn resulting in low intake of vitamin D, (3) the use of sunscreen, and (4) lack of
sunlight exposure (Holick 2004). The decrease in the role of vitamin D is characterized by defective
bone mineralization process in children, in which severe vitamin D deficits may lead to the
defective formation of the skeleton (rickets). Disruption of bone mineralization in the adult can
cause hypocalcaemia and eventually leads to osteomalacia (Lips et al. 2001).
Vitamin D either vitamin D2 or vitamin D3 is rarely found in food. The main sources of
natural vitamin D are fatty fish, such as salmon, mackerel or tuna, mushrooms and also egg yolks.
Vitamin D can also be obtained from food fortified with vitamin D, such as cereal products, bakery
products, baby food, milk, butter, cheese and margarine (Holick 2007).
The purpose of this study is to identify food sources and food habits of female factory
workers, and examined the prospective correlation between the nutrient adequacy level and vitamin
D status.
2. RESEARCH METHODOLOGY
This study used a cross sectional design and was conducted at PT Gunung Salak (garment
factory) in Sukabumi, Indonesia. Sample population was female workers at child bearing age (18-
40 years old) who works in garment factory, 154 worker women. The data collected in this
study was primary type. The primary data was collected through interviews using a
questionnaire and analysis of blood biochemistry (serum 25(OH)D). Serum 25(OH)D) was
determined using a chemiluminesenct immunoassay (CLIA) method. Vitamin D status analysis
was performed by taking blood through the vein by laboratory analyst. Blood samples were
collected in the morning (08.00-11.00 AM) in a non-fasting state. Serum 25(OH)D) was
determined using a chemiluminesenct immunoassay method and analyzed in an accredited
laboratory. The serum 25(OH)D) level was used to evaluate the vitamin D status. The vitamin D
status was classified as deficient (<30 nmol/L), and not deficient (≥30 nmol/L).
Dietary intake was assessed using the 24-h dietary recall method and nutrient intake
determined using Indonesian food composition table. Supplement consumption was categorized
into two groups that are yes and no. Data of repondents‘ characteristics (name, date of birth, ethnic
group, and education), food sources and food habits were collected by questionnaire.
Consumption of energy, protein, fat, vitamin D and calcium were gathered by FFQ and Food Recall
and then categorized below Nutrition Adequacy Level (NAL) and above Nutrition Adequacy Level
(NAL).
3. RESULTS AND DISCUSSION
3.1. Frequency of Food Consumption
Frequency of consumption of meat and vegetable which is containing high vitamin D can be
seen in Table 1. The respondents‘ average consumption of chicken eggs was 20.1 times per month
with an average weight per consumption as much as 56.3 g. Chicken eggs were a food stuff which
was consumed most frequently by the respondents. The high consumption of chicken eggs was due
to their price which was not so expensive and affordable for the respondents as well as their easy
access. The consumption of beef sausage was on average 4.2 kcal in a month, with the weight of

4th Asian Academic Society International Conference (AASIC) 2016
Globalizing Asia: Integrating Science, Technology and Humanities for Future Growth and Development
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10.6 g per serving. Kembung fish (a kind of sea fish) was consumed on average 2.5 times per month
with an average weight of 20.2 g per consumption.
Milk was consumed 2.1 times per month with an average consumption as much as 18.1 g
per serving. While the consumption frequencies tuna and cat fish were 1.6 and 1.3 times per month
respectively with an average consumption of 16.8 g and 10.2 g respectively. The frequency of beef
consumption was on average 1.4 times per month with an average weight of 12.5 g for each
consumption.
Table 1. The frequency of consumption animal and vegetable foods containing vitamin D
Foods
Frequency
(times/per month)
Weight
(g/consumption)
Mean
SD
Mean
SD
Animal Foods
Chicken egg
20.1
16.1
56.3
11.6
Beef sausage
4.2
8.9
10.6
15.7
Kembung fish
2.5
5.1
20.2
25.7
Milk
2.1
6.8
18.1
56.6
Tuna
1.6
3.6
16.8
22.7
Cat fish
1.3
7.5
10.2
22.5
Beef
1.4
5.1
12.5
16.5
Ice cream
1.4
3.4
25.6
38.3
Yoghurt
1.1
4.8
13.4
49.5
Cheese
1.1
5.6
5.9
29.9
Beef Liver
0.9
3.7
4.7
13.0
Sardines
0.7
1.9
5.4
11.3
Shrimp
0.6
1.7
9.2
20.9
Puyuh egg
0.3
1.4
6.0
24.7
Skim milk
0.3
1.6
0.9
3.9
Butter
0.1
1.4
0.1
1.1
Vegetable food
Margarine
3.0
7.9
3.9
6.2
Soybean milk
0.3
1.2
17.1
56.8
Ice cream, yoghurt, and cheese were consumed 1.4 and 1.1 times on average for each month
with an average weight of 25.6 g, 13.4 g, and 5.9 g respectively per consumption. Even though ice
cream was not consumed very frequently, the weight of its consumption was high enough. The
consumption frequencies of beef liver and sardines were 0.9 and 0.7 times per month with an
average of 4.7 and 5.4 g per consumption respectively. On average shrimp was consumed for 0.6
time per month with an average weight of 9.2 g per consumption.
Animal food materials which are rarely consumed by the respondents were quail egg, skim
milk, and butter. The average consumption frequency of quail eggs was 0.3 time per month with the
average weight of 6.0 g for each consumption. Skim milk was also consumed 0.3 time per month on
average but with the weight of 0.9 g for each consumption. On the other hand, butter was consumed
0.11 per month with the weight of 0.1 g for each consumption.
Vegetable food stuffs containing vitamin D which were frequently consumed were
margarine and soybean milk. The average consumption of margarine was 3.0 times per month with
the average weight of 3.9 g for each consumption. While soybean milk was consumed 0.3 time per
month with the weight of 17.1 g for each consumption. Even though soybean milk was very rarely
consumed, its amount for each consumption was significant, that is, 17 g.

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Table 2 Consumption frequency of vegetables and fruits containing vitamin D
Foods
Frequency
(time/per month)
Weight
(g/each consumption)
Mean
SD
Mean
SD
Fruits
Orange
14.6
15.0
80.0
42.7
Banana
8.0
17.9
50.9
50.4
Papaya
6.1
11.3
66.8
71.3
Guava
1.7
9.1
22.7
46.1
Orange juice
0.6
2.8
22.3
68.7
Vegetables
Spinach
6.0
8.6
55.6
60.6
Kangkung (water spinach)
4.3
6.0
32.3
36.4
Bean
4.3
7.6
29.7
27.4
Mushroom
4.1
9.3
36.2
39.9
Running bean
3.0
5.3
28.1
34.0
Brocolli
1.3
3.9
8.6
18.2
The kinds of fruits and vegetables containing vitamin D were very few and rarely consumed
by the respondents. The kinds of fruits which were most frequently consumed by the respondents
were oranges, bananas, and papayas. Oranges were consumed for 14.6 times per month with the
average weight of 80.0 g for each consumption. While bananas were consumed for 8.0 times per
month with the average weight of 50.9 g. Papayas were consumed for 6.1 times per month with the
average weight of 66.8 g for each consumption. Guavas and orange juice were very rarely
consumed. Guavas were consumed 1.7 times per month with the weight of 22.7 g. Orange juice was
consumed 0.6 time per month with the weight of 22.3 g for each consumption.
The vegetable which was consumed most frequently was spinach. Spinach was consumed
for 6.0 per month with the average weight of 55.6 g for each consumption. Kangkung on average
was consumed for 4.3 times per month with the average weight of 32.3 g for each consumption.
Whereas, beans were consumed 4.3 times per month with the weight of 20.7 g. Mushrooms were
consumed for 4.1 times per month with the average weight of 36.3 g for each consumption.
Running beans were consumed for 3.0 times pe month with the average weight of 28.1 g. While
brocolli was very rarely consumed, that is, only 1.3 pe month with the average weight of 8.6 g per
each consumption. Even though the vegetable consumption was high enough, the vitamin D content
in the vegetables was not so high.
Table 3 Distribution of the worker women by nutrient adequacy level
Nutrient Adequacy Level
N
%
Energy
Adequate (≥100%)
16
10.4
Lack (<100%)
138
89.6
Protein
Adequate (≥100%)
47
30.5
Lack (<100%)
107
69.5
Fat
Adequate (ages 19-29 ≤30%; 30-49 ≤25%)
100
64.9
Excessive (ages 19-29 >30%; 30-49 >25%)
54
35.1
Calcium
Adequate (≥100%)
4
2.6
Lack (<100%)
150
97.4
Vitamin D

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
0
0.0
Lack (<100%)
154
100.0
The parameter used for determining the status of vitamin D in this study is the level of
25(OH)D or calcidiol. The vitamin D status of female workers is categorized into: 1) deficient, with
the serum concentration of 25(OH)D under 30 nmol/L; 2) not deficient, with serum concentration of
25(OH)D above 30 nmol/L. The result shows that the level of 25(OH)D serum among the workers
stand s at 31.6 nmol/L. The vitamin D status based on the level of 25(OH)D serum is listed in the
Table 4.
Table 4 Serum vitamin D status of worker women
Serum Vitamin D Status
N
%
Deficient (<30 nmol/L)
73
47.4

81
52.6
Total
154
100.0


31.6 ± 10.6
Vitamin D is not a natural vitamin, because vitamin D can be formed in the body with the
help of sunlight. Naturally, vitamin D is found in fish oil, egg, butter, liver, and fish like mackerel
salmon, and tuna. Nowadays there have been foods with fortified vitamin D especially milk, biscuit,
and cereal. Food from plants generally contains less vitamin D (Kauffman JM. 2009). The more
often someone consumes food rich in vitamin D the better his/her need for vitamin D is fulfilled.
The prevalence of vitamin D deficiency in women of childbearing age (WCBA) in various
countries in Europe, America, and Asia (Malaysia, Singapore, Thailand, Vietnam, India, Japan and
Hong Kong) are varied from 42% to 90%. Until now, the study on the prevalence of vitamin D
deficiency is rarely conducted, moreover on WCBA workers. Among several studies that had been
conducted, for example Oemardi et al. (2007) found that the prevalence of vitamin D deficiency in
women aged 45-
of women aged 60-75 years found that a deficiency of vitamin D was quite high at 35.1%. Recent
study in Indonesia in 504 WCBA aged 18-40 years obtained an average concentration of serum
25(OH)D at 48 nmol/L with deficiency prevalence of 63% (Green et al. 2008).
Table 5 Correlation between the nutrient adequacy level and vitamin D status
Nutrient Adequacy Level
(%)
Not-deficient
(n=81)
Deficient
(n=73)
Total
(n=154)
p
Energy

8 (50.0)
8 (50.0)
16 (100.0)
0.826
Lack (<100%)
73 (52.9)
65 (47.1)
138 (100.0)
Protein

23 (48.9)
24 (51.1)
47 (100.0)
0.546
Lack (<100%)
58 (54.2)
49 (45.8)
107 (100.0)
Fat
Adequate
52 (52.0)
48 (48.0)
100 (100.0)
0.840
Excessive
29 (53.7)
25 (46.3)
54 (100.0)
Calcium

3 (75.0)
1 (25.0)
4 (100.0)
0.363
Lack (<100%)
78 (52.0)
72 (48.0)
150 (100.0)
Vitamin D

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Adequate (≥100%)
0 (0.0)
0 (0.0)
0 (100.0)
Lack (<100%)
81 (52.6)
73 (47.4)
154 (100.0)
3.2. Habit of Supplement Consumption
A health supplement is a product for people‘s health which contains one or more substances
which are nutrients and medicines. Supplements which are nutrients are vitamin, mineral, and
amino acid, whereas supplements which are medicines are generraly taken from plant essence or
animal tissues.
Individuals are at risk of vitamin D insufficiency (<30 mmol/L of serum 25(OH)D)), when
the sunlight exposure they receive is limited, have dark complexion, their skins are protected from
the sun by the glass, wear long dress, use sunscreen or have low intake of vitamin D from their
diets. Prevention of this deficiency at the age of 19-50 years is conducted by taking vitamin D
supplement at least 600 IU/day in order to prevent bone and muscle disorders. However, to increase
serum 25(OH)D more than 30 ng/mL it is recommended to take 1500 to 2000 IU/day of vitamin D
supplement (Holick et al. 2011).
Many multivitamins contain plain vitamin D3 (vitamin D which is standard), which are
nutrient supplements, and now they are available at many markets. In addition, now vitamin D3
which has been hydroxilized in forms of calcitriol and alfacalcidol. Calcitriol is active vitamin D3
(having passed complete hydrocilized) which can directly function by being bound with the receiver
of vitamin D in the intestine so it is able to increase the calcium absorption in the intestine .
Table 6 Habit of supplement consumption
Habit of supplement consumption
N
%
Sopplement Consumption
Yes
57
37.0
No
97
63.0
Kinds of supplements
Vitamin C
14
24.6
Vitamin D
8
14.0
Vitamin E
7
12.3
Fe
4
7.0
Multivitamin and mineral
12
21.1
Herb/Tonic/Medicinal Plants
7
12.3
Others
5
8.8
Consumption frequency (times/week)
3.5 ± 3.8
Number of supplements consumed (tablet
/consumption time)
1.1 ± 0.3
The distribution of the respondents who usually consumed supplements can be observed in
Table 6. The kinds of supplements which were consumed by the respondents were vitamin C,
vitamin D, vitamin E, iron mineral, multivitamin and mineral, herbs, and jamu (processed medicinal
herbs). Most of the respondents did not consume supplements The respondents who were used to
consuming supplement were 37.0% and the rest (63.0%) did not consume.
Table 7 Correlation between supplement consumption and vitamin D status
Supplement
Consumption
Not deficient
(n=81)
Deficient
(n=73)
Total
(n=154)
p
Yes
31 (54.4)
26 (45.6)
57 (100.0)
0.733
No
50 (51.5)
47 (48.5)
97 (100.0)

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Of those who were used to consuming supplements, most consumed supplements in form of
vitamin, that is, vitamin C (24.5%). Another supplement which was consumed was vitamin D, that
is, 14.0%. While the kinds of supplements which were consumed relatively high were multivitamin
and mineral. The respondents which consumed supplement multivitamin and mineral were 21.1%.
Some (12.3%) of the rest consumed vitamin E, 7.0% Fe, and 12.3% consumed herbs. The frequency
of supplement consumption was 3.5 times per week with 1.12 tablets per consumption time.
The 18-to-40 year-old female factory workers who consumed supplements were 57. The
majority of the female factory workers consumed supplements containing vitamin C, vitamin E and
drinks to boost stamina while the habit of consuming supplements containing vitamin D (CDR) was
done only by 8 female factory workers (Tabel 7). The result of this study concluded that the female
factory workers who consumed supplements were 54.4% had their vitamin D belong to category not
deficient but there was no correlation between the habit of consuming supplements and their
vitamin D status (p value = 0.733).
4. CONCLUSION
Animal-sourced foods as a vitamin D source which were frequently consumed by the
subjects were egg, sausage, and kembung fish, whereas vegetable-sourced food as a vitamin D
source which was frequently consumed was margarine, eventhough the amount consumed was still
relatively low. Fruit as vitamin D source which was frequently consumed was orange with an
average consumption of three times/week and the amount consumed was 80.0 g/serving. The
consumption of spinach as a source of vitamin D was only 1 to 2 times per week with an average
consumption amount of 56 g/eating time. There were only 14% of the subjects who were used to
consuming a vitamin D supplement and 21% consuming multivitamin and mineral.
ACKNOWLEDGMENT
The authors would like to thank the Neys-van Hoogstraten Foundation for funding the
study. Gratitude is also expressed to the head management, staffs, and workers of PT. GS for their
support in this study.
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