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Differences and determinants of vitamin D deficiency among UK biobank participants: A cross-ethnic and socioeconomic study
Abstract
Background
The public health relevance of true vitamin D deficiency is undisputed, although controversy remains regarding optimal vitamin D status. Few contemporary cross-ethnic studies have investigated the prevalence and determinants of very low 25-hydroxyvitamin D [25(OH)D] concentrations.
Methods
We conducted cross-ethnic analyses on the prevalence and determinants of vitamin D deficiency (25(OH)D ≤ 25 nmol/L) using data from 440,581 UK Biobank participants, of which 415,903 identified as White European, 7880 Asian, 7602 Black African, 1383 Chinese, and 6473 of mixed ancestry. Determinants of vitamin D deficiency were examined by logistic regression.
Results
The prevalence of vitamin D deficiency was highest among participants of Asian ancestry (57.2% in winter/spring and 50.8% in summer/autumn) followed by those of Black African ancestry (38.5% and 30.8%, respectively), mixed (36.5%, 22.5%), Chinese (33.1%, 20.7%) and White European ancestry (17.5%, 5.9%). Participants with higher socioeconomic deprivation were more likely to have 25(OH)D deficiency compared to less deprived participants (P = <1 × 10−300); this pattern was more apparent among those of White European ancestry and in summer (Pinteraction ≤6.4 × 10−5 for both). In fully-adjusted analyses, regular consumption of oily fish was associated with reduced odds of vitamin D deficiency across all ethnicities, while outdoor-time in summer was less effective for Black Africans (OR 0.89, 95% CI 0.70, 1.12) than White Europeans (OR 0.40, 95% CI 0.38, 0.42).
Conclusions
Severe vitamin D deficiency remains an issue throughout the UK, particularly in lower socioeconomic areas. In some groups, levels of deficiency are alarmingly high with one-half of Asian and one-third of Black African ancestry populations affected across seasons.
Key messages
The prevalence of vitamin D deficiency in the UK is alarming, with certain ethnic and socioeconomic groups considered particularly vulnerable.
... However, different authorities use different threshold of serum 25(OH)D to define vitamin D deficiency, for example, 25 nmol/l for Scientific Advisory Committee on Nutrition (2) in the UK, 30 nmol/l for the Institute of Medicine, and 50 nmol/l for the European Food Safety Authority and Endocrine Society and no current consensus exists (3) . Vitamin D deficiency is prevalent worldwide reported as 9⋅9 % in the USA (4) , 7⋅4 % in Canada (5) , 4⋅6-30⋅7 % in Western Europe (6) (defined as serum 25(OH)D < 30 nmol/l) and 18⋅8 % during winter and spring and 7⋅5 % during summer and autumn in the UK (defined as serum 25(OH)D concentration < 25 nmol/l) (7) . Evidence from observational studies shows that vitamin D deficiency is significantly associated with increased risks to musculoskeletal disease such as osteomalacia and non-musculoskeletal health outcomes including hypertension, obesity, cardiovascular disease (CVD) and diabetes, mortality from respiratory diseases and reduced lung functions, immune responses (8,9) and advanced cancers (metastatic or fatal) (10) , although some large-scaled randomised controlled trials (RCTs) could not confirm the effect of vitamin D supplementation on the lower risk of fractures among generally healthy midlife and older adults (11) or of the major adverse cardiovascular events in postmenopausal women (12) and middle-aged and older adults (13) . ...
... The categorical data (variables) included in the study are shown in Table 1. Instead of using four seasons, two seasons covering the whole year was adopted, defined as summer-autumn (June-November) and winter-spring (December-May) used in other studies (7,21) . Though different thresholds of serum 25 (OH)D were used to define vitamin D deficiency, most studies with SCI patients used serum 25(OH)D < 50 nmol/l as a threshold of vitamin D deficiency, and serum 25(OH)D > 75 nmol/l as optimal or sufficient vitamin D status (14) . ...
... In addition, BMI, blood total cholesterol and creatinine showed inverse association serum 25(OH)D and were significant predictors of serum 25(OH)D in this population. The present study showed 24 % vitamin D deficient (serum 25(OH)D < 25 nmol/l) in SCI patients, with 30⋅2 % in winter-spring v. 12⋅9 % in summer-autumn (P = 0⋅007), much higher than the general population reported in a large cohort of 440 581 UK Biobank participants (7) which showed 18⋅6 % of vitamin D deficiency in winter-spring and 7⋅5 % in summer-autumn period. Our results also showed male SCI patients had a significant higher prevalence of vitamin D deficiency compared with female SCI patients (28 % v. 11⋅8 %, P = 0⋅02), while Sutherland's results showed similar vitamin D deficiency between genders (7⋅4 % for males v. 7⋅6 % for females in the summer-autumn period, and 19⋅2 % for males v. 18⋅5 for females in the winter-spring period) (7) . ...
Vitamin D deficiency is prevalent in patients with chronic spinal cord injury (SCI) and has been implicated as an aetiologic factor of osteoporosis and various skeletal and extra-skeletal issues in SCI patients. Few data were available regarding vitamin D status in patients with acute SCI or immediately assessed at hospital admission. This retrospective cross-sectional study evaluated vitamin D status in SCI patients at admission to a UK SCI centre in January–December 2017. A total of 196 eligible patients with serum 25(OH)D concentration records at admission were recruited. The results found that 24 % were vitamin D deficient (serum 25(OH)D < 25 nmol/l), 57 % of the patients had serum 25(OH)D < 50 nmol/l. The male patients, patients admitted in the winter–spring time (December–May), and patients with serum sodium < 135 mmol/l or with non-traumatic causes had a significant higher prevalence of vitamin D deficiency than their counterparts (28 % males v. 11⋅8 % females, P = 0⋅02; 30⋅2 % in winter–spring v. 12⋅9 % in summer–autumn, P = 0⋅007; 32⋅1 % non-traumatic v. 17⋅6 % traumatic SCI, P = 0⋅03; 38⋅9 % low serum sodium v. 18⋅8 % normal serum sodium, P = 0⋅010). There was a significant inverse association of serum 25(OH)D concentration with body mass index (BMI) ( r = −0⋅311, P = 0⋅002), serum total cholesterol ( r = −0⋅168, P = 0⋅04) and creatinine concentrations ( r = −0⋅162, P = 0⋅02) that were also significant predictors of serum 25(OH)D concentration. Strategies for systematic screening and efficacy of vitamin D supplementation in SCI patients need to be implemented and further investigated to prevent the vitamin D deficiency-related chronic complications.
... Vitamin D is a hormone precursor that is synthesized in the skin during UVB radiation from sunlight exposure [1]. The primary circulating vitamin D metabolite in the body is 25-hydroxyvitamin D [25(OH)D] and is used as an indicator for vitamin D status [2]. ...
... The primary circulating vitamin D metabolite in the body is 25-hydroxyvitamin D [25(OH)D] and is used as an indicator for vitamin D status [2]. Most vitamin D is obtained through sunlight exposure [1,3]; dietary sources only account for between 10 and 20% of the body's total store [4], as few foods contain vitamin D naturally and fortification of foods in the UK is limited [2,5]. Vitamin D is a key regulator of calcium and phosphorous metabolism in children and adults [6] and is critical for bone health [7], through the mediation of osteogenic-related mineral absorption and utilization for skeletal development and maintenance [1]. ...
... Most vitamin D is obtained through sunlight exposure [1,3]; dietary sources only account for between 10 and 20% of the body's total store [4], as few foods contain vitamin D naturally and fortification of foods in the UK is limited [2,5]. Vitamin D is a key regulator of calcium and phosphorous metabolism in children and adults [6] and is critical for bone health [7], through the mediation of osteogenic-related mineral absorption and utilization for skeletal development and maintenance [1]. Furthermore, due to the presence of vitamin D receptors expressed in almost every tissue and cell, there have been a substantial number of investigations into the effects of vitamin D that are extra-skeletal [8][9][10][11][12][13][14][15]. ...
Vitamin D deficiency is a serious public health issue in the United Kingdom. Those at increased risk, such as pregnant women, children under 5 years and people from ethnic groups with dark skin, are not all achieving their recommended vitamin D. Effective vitamin D education is warranted. A qualitative study was undertaken to evaluate the acceptability and understanding of a vitamin D infographic, developed using recommendations from previous research. Fifteen parents/carers, recruited through local playgroups and adverts on popular parent websites, participated in focus groups and telephone interviews. The majority were female, White British and educated to degree level. A thematic analysis methodology was applied. The findings indicated that understanding and acceptability of the infographic were satisfactory, but improvements were recommended to aid interpretation and create more accessible information. These included additional content (what vitamin D is; other sources; its health benefits; methods/doses for administration and scientific symbols used) and improved presentation (eye-catching, less text, simpler language, more images and a logo). Once finalized, the infographic could be a useful tool to educate families around vitamin D supplementation guidelines, support the UK Healthy Start vitamins scheme and help improve vitamin D status for pregnant and lactating women and young children.
... Europeans, but notably lower in South Asians [105]. Similarly, deficiency was high in all groups in Belgium and Finland, with the highest in the Moroccan group in Belgium [106] and Somali group in Finland [107]. ...
... Average serum calcidiol concentration in population groups with the darkest skin was frequently two-thirds that of the lightest skin, while vitamin D deficiency was three times higher. Deviations from this rule occurred only in populations with markedly high [97,[105][106][107] or low [110] rates of deficiency in all groups. These observational data show a consistent effect of dark skin on vitamin D status in many countries, which indicates that skin pigmentation can reduce vitamin D synthesis by up to one third. ...
... 51 VitD deficiency in minorities in the UK is well known and is described as an unrecognised 52 epidemic (8) . In the UK, 50% of SAs and 33% of black ACs demonstrate vitD deficiency, whereas 53 17.5% of white Caucasians do (9) , which is primarily due to more subcutaneous pigmentation that 54 absorbs ultraviolet B from sunlight and reduces vitD production in the skin and at high latitudes in 55 the UK (10) . This situation is worse in East London. ...
In the UK, black African-Caribbeans (ACs) and South Asians (SAs) have 3–6 times greater risks of developing diabetes than white Caucasians do. East London is among the areas with the highest prevalence of type 2 diabetes and the highest proportion of minority groups. This ethnic health inequality is ascribed to socioeconomic standing, dietary habits, culture, and attitudes, while biological diversity has rarely been investigated. The evidence shows that the postprandial glucose peak values in SAs are 2–3 times greater than those in white Caucasians after the same carbohydrate loads; however, the mechanism is poorly understood. In the UK, 50% of SAs and 33% of ACs have vitamin D (vitD) deficiency, whereas 18% of white Caucasians have vitamin D deficiency. There is evidence that vitD status is inversely associated with insulin resistance in healthy adults and diabetic patients and that vitD supplementation may help improve glycaemic control and insulin resistance in type 2 diabetes patients. However, little evidence is available on minority groups or East London. This study will investigate the postprandial glycaemic response (PGR) in three ethnic groups (white Caucasians, SAs and ACs) in East London and link PGR to plasma 25(OH)D (an indicator of vitD status). Ninety-six healthy adults (n=32 per group) will be recruited. Two test drinks will be provided to the participants (300 ml of glucose drink containing 75 g glucose, and 300 ml of pure orange juice) on different occasions. PGR is monitored before and after drinking every 30 min for up to 2 hours via finger prick. A fasting blood sample obtained via phlebotomy will be used for 25(OH)D and relevant tests. A knowledge/perception questionnaire about vitD and a 4-day food diary (analysing vitD dietary intake) will also be collected. The findings of the study will be shared with participants, published in journals, disseminated via social media, and used to inform a randomized controlled trial of the effects of vitD supplementation on PGR in minority groups. The study complies with the Helsinki Declaration II and was approved by the Senate Research Ethics Committee at City, University of London (ETH2223-2000). The study findings will be published in open access peer-reviewed journals and disseminated at national and international conferences. ClinicalTrials.gov Identifier: NCT06241976
... Participants were asked to select race from the options: White participants, mixed participants, Asian or Asian British participants, Black or Black British participants, Chinese participants, "other" ethnic group, do not know, or prefer not to answer. Considering a small number of participants in mixed, Chinese, and "other" ethnic group, the options were collapsed into 4 primary ethnic groups, including White participants, mixed participants (adding the "other" ethnic group), Asian or Asian British participants (adding Chinese group), and Black or Black British participants [36,37]. Townsend Deprivation Index (TDI) reflected socioeconomic status and was calculated with national census data according to postcodes of residence [38]. ...
... Both gender-specific and socioeconomic statuses have emerged as parameters potentially affecting vitamin D levels in humans (Sutherland et al. 2021). Gender-wise, recent studies highlight a higher prevalence of vitamin D deficiency in males, possibly attributed to a more sedentary lifestyle, reducing sunlight exposure time (Ravelo et al. 2022). ...
Vitamin D deficiencies are linked to multiple human diseases. Optimizing its synthesis, physicochemical properties, and delivery systems while minimizing side effects is of clinical relevance and is of great medical and industrial interest. Biotechnological techniques may render new modified forms of vitamin D that may exhibit improved absorption, stability, or targeted physiological effects. Novel modified vitamin D derivatives hold promise for developing future therapeutic approaches and addressing specific health concerns related to vitamin D deficiency or impaired metabolism, such as avoiding hypercalcemic effects. Identifying and engineering key enzymes and biosynthetic pathways involved, as well as developing efficient cultures, are therefore of outmost importance and subject of intense research. Moreover, we elaborate on the critical role that microbial bioconversions might play in the a la carte design, synthesis, and production of novel, more efficient, and safer forms of vitamin D and its analogs. In summary, the novelty of this work resides in the detailed description of the physiological, medical, biochemical, and epidemiological aspects of vitamin D supplementation and the steps towards the enhanced and simplified industrial production of this family of bioactives relying on microbial enzymes.
Key points
• Liver or kidney pathologies may hamper vitamin D biosynthesis
• Actinomycetes are able to carry out 1α- or 25-hydroxylation on vitamin D precursors
... In the present study, we found a decreased risk of vitamin D deficiency in patients consuming cacao products and sardines either rarely or frequently, compared to those never consuming them. Similar findings were recently reported in the UK and Nepal [28,48]. Fishes such as sardines are known to have a high content of vitamin D [2,3]. ...
Background and aim
Vitamin D deficiency (VDD) is a global public health problem in African populations. This study aimed at determining the prevalence, characteristics, and determinants of VDD in the era of SARS-CoV-2/COVID-19. This study was conducted from January to September 2022 in seven health facilities in Douala, Cameroon.
Methods
A structured, pre-tested questionnaire was administered to each participant to collect participants’ information. Molecular detection of the SARS-CoV-2 genome was done. A serum level of 25-hydroxyvitamin D < 20 ng/mL was used to diagnose VDD.
Results
A total of 420 participants were included in the study. A Serum levels of 25(OH) vitamin D were reduced in SARS-CoV-2 (+) patients as compared to SARS-CoV-2 (-) patients (21.69 ± 5.64 ng/mL vs 42.09 ± 20.03 ng/mL, p < 0.0001). The overall prevalence of VDD was 10.2 %. SARS-CoV-2 (+) individuals had nearly two times more risk of being VDD compared to SARS-CoV-2 (-) individuals (aRR = 1.81, p < 0.0001). The risk of VDD was reduced by 46 % and 71 % in those consuming cocoa bean or powder regularly (aRR = 0.54, p = 0.03) and rarely (aRR = 0.29, p = 0.02) as compared to those never consuming it. Likewise, the risk of VDD was reduced by 59 % and 78 % in those consuming sardine fish regularly (aRR = 0.47, p = 0.002) and rarely (aRR = 0.22, p = 0.03). Overall, the association between VDD and SARS-CoV-2 infection was consistent, i.e., reduced risk of VDD in SARS-CoV-2 (-) individuals, after stratification for confounding variables.
Conclusion
This study outlined a high burden of VDD, a strong link between VDD and SARS–CoV–2, and suggests the possible utility of vitamin D supplementation for COVID-19 patients in Cameroon.
... This geographical uniqueness poses a potential limitation when extrapolating our findings, especially to populations experiencing variations in sun exposure due to seasonal changes, considering the effect of sunlight on vitamin D synthesis [53]. However, despite the availability of sunlight, numerous studies have identified that vitamin D deficiency is more prevalent in Asians [54,55]. This can be attributed to factors such as darker skin pigmentation, which adversely affects the speed of vitamin D synthesis, as well as prevalent sun-avoidance behaviours and a dietary pattern lacking in foods high in vitamin D [54,56]. ...
The impact of vitamin D supplementation on 25-hydroxyvitamin D (25OHD) levels, metabolic status, and pregnancy outcomes in pregnant women with overweight and obesity (OW/OB) is uncertain. This study aimed to examine whether administrating 800 IU of vitamin D3 orally would improve maternal serum 25OHD levels, lipid profile, and pregnancy outcomes compared to 400 IU. This was a two-arm, parallel, non-blinded randomised controlled trial involving 274 pregnant women recruited from KK Women’s and Children’s Hospital, with a body mass index of ≥25 kg/m2 within 16 weeks gestation. The participants were randomly assigned to receive 800 IU/day (intervention group) or 400 IU/day (control group) of oral vitamin D3 supplements. The primary outcomes were maternal serum 25OHD and lipid levels at 24–28 weeks gestation. The secondary outcomes included maternal and birth outcomes. Compared with controls (n = 119), the intervention group (n = 112) exhibited higher 25OHD levels at 24–28 weeks gestation (adjusted mean difference 6.52 nmol/L; 95% confidence interval 2.74, 10.31). More women in the intervention group achieved sufficient 25OHD levels (77.7% vs. 55.5%; p < 0.001). No differences were observed in lipid profiles or maternal or birth outcomes between the groups. An additional 400 IU of oral vitamin D3 supplementation increased serum 25OHD levels but did not impact lipid profiles or pregnancy outcomes.
... Ethnicity is another factor that plays a role in influencing vitamin D concentration. Vitamin D deficiency is more common among African Americans (blacks) than other Americans (Sutherland et al., 2021). Whereas risk factors for dementia, such as hypertension and diabetes, are more frequent in black and other ethnic minorities (Clark et al., 2018). ...
... These results corroborate with other studies that highlighted diet as a mediator in the relationship between the disadvantageous economic situation with caries (Stein et al., 2021) and periodontitis . Low family income can impact food choices through cheap energy-dense food items rich in trans fats and sugary drinks and poor vitamin D (Sutherland et al., 2021), contributing to a higher burden of chronic oral diseases. ...
Objective:
To investigate pathways from micronutrient intake and serum levels to Chronic Oral Diseases Burden.
Methods:
We analyzed cross-sectional data from NHANES III (n = 7936) and NHANES 2011-2014 (n = 4929). The exposure was the intake and serum levels of vitamin D, calcium, and phosphorus. Considering the high correlation of those micronutrients in the diet, they were analyzed as a latent variable dubbed Micronutrient intake. The outcome was the Chronic Oral Diseases Burden, a latent variable formed by probing pocket depth, clinical attachment loss, furcation involvement, caries, and missing teeth. Pathways triggered by gender, age, socioeconomic status, obesity, smoking, and alcohol were also estimated using structural equation modeling.
Results:
In both NHANES cycles, micronutrient intake (p-value < 0.05) and vitamin D serum (p-value < 0.05) were associated with a lower Chronic Oral Diseases Burden. Micronutrient intake reduced the Chronic Oral Diseases Burden via vitamin D serum (p-value < 0.05). Obesity increased the Chronic Oral Diseases Burden by reducing vitamin D serum (p-value < 0.05).
Conclusion:
Higher micronutrient intake and higher vitamin D serum levels seem to reduce Chronic Oral Diseases Burden. Healthy diet policies may jointly tackle caries, periodontitis, obesity, and other non-communicable diseases.
... The level of education is an element of socioeconomic status as a risk factor for the level of vitamin D and health in some national studies. Its statistically significant influence is proved [21], [22], [23], [24], [25]. ...
BACKGROUND: The influence of the factors on Vitamin D as a health indicator in premenopausal and menopausal women is a significant subject to be investigated. AIM: The study uses the potential of classification and regression trees (CART) as a data mining method for medical type samples. METHODS: The data set is built by records of 84 indoor working women at the age of 45 to 67 years from five Bulgarian companies. The data are obtained through laboratory tests of serum concentrations of 25-OH-Vitamin D and a questionnaire, created for the study. Statistical data processing is made by descriptive statistics and the CART method. RESULTS: The results show Vitamin D deficiency in 69% of the studied women at risk from Stara Zagora. For the target variable – Vitamin D (the quantity of 25-OH-Vitamin D), a regression CART tree was built. The calculated percentages of normalized importance for each independent variable reveal that the most important predictors, affecting Vitamin D, are body mass index (100%), alcohol (84.2%), education (70.3%), coffee (70.2%), Са_Vit D (69.8%), and sports frequency (42.4%), while the other variables have much less importance. CONCLUSION: The application of the CART method makes it possible to study the distribution and importance of the factors influencing the state of vitamin D. The presence of such a high percentage of women at risk requires a comprehensive approach, including educational programs and strict application of guidelines for vitamin D supplementation to prevent the effects of hypovitaminosis.
... There is evidence that socioeconomic deprivation, which is assessed in various ways in the literature such as SES index or individual income data, is associated with lower 25OHD levels (19)(20)(21). Data from pregnant women in the US showed an association of maternal 25OHD with SES, but after multivariable analysis including ethnicity, vitamin D supplement use and physical activity, the association with SES was no longer evident (22). ...
Objectives
Vitamin D deficiency in neonates can have life-threatening consequences, hence the knowledge of risk factors is essential. This study aimed to explore the effect of maternal socioeconomic status (SES) on newborn 25-hydroxyvitamin D (25OHD) concentrations.
Design
Over two 1-week periods (winter and summer of 2019), 3000 newborn heel prick dried blood spots (DBS) and additional data of newborns, from a regional newborn screening laboratory (52° N) in the West Midlands, UK, were gathered. Post code was replaced with lower layer super output area (LSOA). Index of Multiple Deprivation (IMD) quintiles for the corresponding LSOA was used to assess SES [quintile one (Q1): most deprived 20%, quintile five (Q5): least deprived 20%]. Each of the seven domains of deprivation were examined (income, employment, education, health, barriers to housing and services, crime and living environment). 25OHD was measured on 6mm sub-punch from DBS using quantitative liquid chromatography tandem mass spectrometry and equivalent plasma values were derived.
Results
In total 2999 (1500 summer-born, 1499 winter-born) newborn DBS (1580 males) were analysed. Summer-born newborns had significantly higher 25OHD (IQR) concentrations [49.2 (34.3; 64.8) nmol/l] than winter-born newborns [29.1 (19.8; 40.6) nmol/l, p<0.001].25OHD levels varied significantly between the different IMD quintiles in the whole (p<0.001) and summer-born cohort (p<0.001), but not in the winter-born cohort (p=0.26), whereby Q1 had the lowest 25OHD concentrations. Among the domains of deprivation, living environment had a significant influence on 25OHD levels (β=0.07, p=0.002). In this subdomain, 25OHD levels varied significantly between quintiles in the whole (p<0.001) and summer-born cohort (mean 25OHD Q1 46.45 nmol/l, Q5 54.54 nmol/l; p<0.001) but not in the winter-born cohort (mean 25OHD Q1 31.57 nmol/l, Q5 31.72 nmol/l; p=0.16). In a regression model, living environment was still significant (p=0.018), albeit less than season of birth and ethnicity.
Conclusion
Among the seven domains of deprivation, maternal living environment had the greatest effect on newborn 25OHD levels. Whilst improved living environment positively influenced vitamin D status in the summer-born babies, winter-born had low 25OHD levels irrespective of the environment. Strategies such as enhanced supplementation and food fortification with vitamin D should be considered to overcome the non-modifiable main risk factors for vitamin D deficiency.
... Few have examined the association with dietary or specific food intakes, though fortified milk, fish and egg consumption were found to be positive determinants in older adults and adolescents (4,10,16) . Biophysical factors such as increased BMI and female sex were also associated with lower vitamin D status in children and older Irish adults (7,9,(16)(17)(18) while smoking, living alone and lower socio-economic status have been found to be negative predictors (9,10,19) . ...
Vitamin D deficiency is common in Irish adults, though there is limited research on its determinants, knowledge of vitamin D or indications for testing. We aimed to explore the determinants of vitamin D status in adults and examine knowledge and reasons for testing. The study population comprised adults who had serum 25-hydroxyvitamin D tested by general practitioners request at a Dublin Hospital in 2020. Questionnaires detailing dietary intake, sun exposure, ethnicity, biophysical factors and vitamin D knowledge were sent to a sample stratified by age, sex and vitamin D status. In total, there were 383 participants, mean age 56·0 ( sd 16·6) years. Wintertime deficiency disproportionally affected non-white v . white (60 % v . 24 %, P < 0·001). The greatest predictors of deficiency were low vitamin D intake (< 10 μg/d) ( P < 0·001) and non-white ethnicity ( P = 0·006), followed by sun avoidance ( P = 0·022). It was also more prevalent in those with lower body exposure when outdoors. The majority (86 %) identified vitamin D as important for bone health. However, 40 % were tested for non-clinical indications and half were not aware of the recommended daily allowance (RDA). Low vitamin D intake was the most important determinant of deficiency, but ethnicity and sun exposure habits were also significant predictors. The majority had no clear indication for testing and were not aware of the RDA. Public health policies to improve knowledge and vitamin D intake, especially for those of non-white ethnicity and with reduced sun exposure, should be considered.
... Interestingly, this prevalence is somewhat lower than in studies involving the UK general population. In a UK Biobank study of approximately 440,000 participants, 25OHD levels in winter and spring were <50 nmol/L 46% and <25nmo/L 18%, so overall prevalence was 63% (Sutherland et al., 2021). We would suggest the reasons for this disparity include the much larger sample size, the inclusion of more participants from ethnic minority backgrounds and the deprivation levels reported in the biobank study. ...
Aims
To determine the prevalence of vitamin D deficiency in adults with Crohn's Disease (CD) in Birmingham, UK (latitude 52.4°N, −1.9°E) and identify modifiable risk factors.
Design/Method
A nurse‐led, single‐centre, prospective study was conducted over 5 months in 2019 and 2020 in outpatients with CD, at a tertiary referral hospital in Birmingham UK. Vitamin D (25OHD) levels were measured at a single timepoint by a dried blood spot sample. Modifiable risk factor data were collected including intake of vitamin D‐containing foods, use of vitamin D supplements, sun exposure and current smoking.
Results
Total 150 participants (53.3% male, 79.3% white British). Vitamin D deficiency (25OHD <50 nmol/L) was found in 53.3%. 32.7% of participants took over‐the‐counter vitamin D supplements and 20.7% used prescribed supplements. We found that diets were generally poor in relation to vitamin D‐rich foods. In terms of sun exposure, few (18%) had visited a sunny country recently, and few (6%) covered their whole body with clothing. Most used High Sun Protection Factor (80%) with a median grade of SPF 45.
Conclusion
Patients with CD are at high risk of vitamin D deficiency as defined by 25OHD < 50 nmol/L, with the prevalence of deficiency being highest during the winter months. Patients with CD in the UK are unlikely to maintain vitamin D levels from sunlight exposure, dietary sources or over‐the‐counter supplements.
Impact
Patients with Crohn's Disease are at high risk of developing vitamin D deficiency but there is little data from the UK at this latitude.
We demonstrate the prevalence and severity of vitamin D deficiency in people with Crohn's Disease in the UK.
The prevalence of vitamin D deficiency in this group is high and warrants monitoring by nurses and clinical teams. Nurses and clinical teams should consider strategies for vitamin D supplementation in patients with Crohn's Disease.
... The strongest effects were seen for persons with measured 25-(OH)D concentrations in the severe deficiency range (<25 nmol/L). Although the past decade has seen benefits in some settings through increases in food fortification and updates on policy guidelines (28,29), recent estimates for the prevalence of severe deficiency range from 5% to 50%, with rates varying by geographic location and population characteristics (28,(30)(31)(32). Therefore, our study affirms the potential for a notable effect on premature death and the continued need for efforts to abolish vitamin D deficiency. ...
Background:
Low vitamin D status is associated with increased mortality, but randomized trials on severely deficient participants are lacking.
Objective:
To assess genetic evidence for the causal role of low vitamin D status in mortality.
Design:
Nonlinear Mendelian randomization analyses.
Setting:
UK Biobank, a large-scale, prospective cohort from England, Scotland, and Wales with participants recruited between March 2006 and July 2010.
Participants:
307 601 unrelated UK Biobank participants of White European ancestry (aged 37 to 73 years at recruitment) with available measurements of 25-hydroxyvitamin D (25-(OH)D) and genetic data.
Measurements:
Genetically predicted 25-(OH)D was estimated using 35 confirmed variants of 25-(OH)D. All-cause and cause-specific mortality (cardiovascular disease [CVD], cancer, and respiratory) were recorded up to June 2020.
Results:
There were 18 700 deaths during the 14 years of follow-up. The association of genetically predicted 25-(OH)D with all-cause mortality was L-shaped (P for nonlinearity < 0.001), and risk for death decreased steeply with increasing concentrations until 50 nmol/L. Evidence for an association was also seen in analyses of mortality from cancer, CVD, and respiratory diseases (P ≤ 0.033 for all outcomes). Odds of all-cause mortality in the genetic analysis were estimated to increase by 25% (odds ratio, 1.25 [95% CI, 1.16 to 1.35]) for participants with a measured 25-(OH)D concentration of 25 nmol/L compared with 50 nmol/L.
Limitations:
Analyses were restricted to a White European population. A genetic approach is best suited to providing proof of principle on causality, whereas the strength of the association is approximate.
Conclusion:
Our study supports a causal relationship between vitamin D deficiency and mortality. Additional research needs to identify strategies that meet the National Academy of Medicine's guideline of greater than 50 nmol/L and that reduce the premature risk for death associated with low vitamin D levels.
Primary Funding Source:
National Health and Medical Research Council.
... In an earlier genome-wide GxE analysis, carriers of 25(OH)D-lowering allele at the CYP2R1 locus were less responsive to dietary vitamin D intake [16]. A similar interaction with vitamin D lowering alleles has also been observed in the context of the GC locus and vitamin D supplementation [87], of vitamin D3-fortified bread and milk consumption [86,87] and UVB treatment [88,89]. ...
Twin studies suggest a considerable genetic contribution to the variability in 25-hydroxyvitamin D (25(OH)D) concentrations, reporting heritability estimates up to 80% in some studies. While genome-wide association studies (GWAS) suggest notably lower rates (13–16%), they have identified many independent variants that associate with serum 25(OH)D concentrations. These discoveries have provided some novel insight into the metabolic pathway, and in this review we outline findings from GWAS studies to date with a particular focus on 35 variants which have provided replicating evidence for an association with 25(OH)D across independent large-scale analyses. Some of the 25(OH)D associating variants are linked directly to the vitamin D metabolic pathway, while others may reflect differences in storage capacity, lipid metabolism, and pathways reflecting skin properties. By constructing a genetic score including these 25(OH)D associated variants we show that genetic differences in 25(OH)D concentrations persist across the seasons, and the odds of having low concentrations (<50 nmol/L) are about halved for individuals in the highest 20% of vitamin D genetic score compared to the lowest quintile, an impact which may have notable influences on retaining adequate levels. We also discuss recent studies on personalized approaches to vitamin D supplementation and show how Mendelian randomization studies can help inform public health strategies to reduce adverse health impacts of vitamin D deficiency.
... Moreover, fish and seafood intake resulted in higher n-3 PUFA and vitamin status, in a Canadian population studied from 2004 until 2015, [154], while in a study of 440,581 UK Biobank participants, regular consumption of oily fish was associated with reduced odds of vitamin D deficiency across all ethnicities (white European, Asian, black African, Chinese, and mixed ancestry) of this UK population [155]. Furthermore, the natural fish diet of coastal Kerala and the latitude seems to be protective against vitamin D deficiency in children and the overall population of this territory in India, where a low prevalence of vitamin D deficiency has been observed [156]. ...
The beneficial effects of fish-derived lipid bioactives have come to prominence over the last few decades, especially for their utilization in fish oils, supplements, and nutraceuticals. Omega-3 (n-3) polyunsaturated fatty acids (PUFA), lipid vitamins, carotenoids, and polar lipid bioactives from fish have shown to possess a vast range of beneficial effects against a multitude of chronic disorders and especially against inflammation-and cardiovascular disorders (CVD). The observed cardio-protective effects and health benefits are believed to be attributed to the synergy of these fish-derived lipid bioactives. Within the present article the recent findings in the literature on the lipid content of the mainly consumed fish species, their bio-functionality, and cardio-protective benefits is thoroughly reviewed. Moreover, the recovery and valorization of such lipid bioactives from fish by-products and fishing by-catch, in order to reduce waste, while developing useful products containing cardio-protective lipids from the leftover materials of fisheries and aquaculture industries, are also of industrial and environmental interest. Emphasis is also given to the effects of heat treatments during fish processing on the structures and bio-functionality of these marine lipid bioactives, based on the paradigm of different cooking methodologies and thermal processing, while the compounds produced during such treatment(s) with detrimental changes in the fish lipid profile, which can reduce its cardio-protective efficacy, are also reviewed. Novel green extraction technologies and low temperature processing and cooking of fish and fishery by-products are needed to reduce these undesirable effects in a sustainable and environmentally friendly way.
... However, when measured, it was found to be low in the majority of participants (12.28 ng/mL ± 5.2). Keeping in mind that vitamin D 3 deficiency is a worldwide problem [34][35][36][37][38], this group reflected the actual vitamin D 3 level in the general population. Although serum calcium and phosphate level were low in the CG, they were still within the normal range. ...
Objectives:
To investigate the effect of vitamin D3 level on the alignment of mandibular anterior teeth in adults and explore the associated root resorption and pain perception. Trial Design. Multicentre, double blinded randomized clinical trial. Subjects and Methods. Adult patients aged 18-30 years, with moderate mandibular incisor crowding [Little's Irregularity index (LII) 3-6 mm], needing nonextraction treatment with fixed orthodontic appliance, were randomly allocated into two groups with 1 : 1 allocation ratio. In the 1st group (normal vitamin D3 level group [ND3G]), vitamin D level was measured and corrected to normal before starting orthodontic treatment, while in the 2nd group [control group (CG)] the vitamin D level was kept unknown until completion of the alignment phase. Outcome measures included mandibular incisor crowding using LII, orthodontically induced root resorption (OIRR), and pain perception. Independent sample t-test was used to compare the duration of treatment, the effectiveness of alignment, and OIRR between groups, while differences in pain perception were analysed by Mann-Whitney U-test (P < 0.05).
Results:
Out of 87 patients recruited from four centres, 33 patients were randomly allocated into two groups (17 patients to ND3G and 16 patients to CG). Time elapsed for the complete alignment of the mandibular incisor crowding was one month shorter in ND3G (23.532% faster), and the improvement percentage was significantly higher in all periods when compared to the CG. The amount of OIRR was not significantly different between groups; however, pain during the first three days of alignment was significantly less in ND3G.
Conclusions:
Having optimal vitamin D3 level reduced the alignment time and pain associated with orthodontic treatment, but it had no role in reducing OIRR. Registration. The trial was registered with ClinicalTrials.gov on 12th April 2021 (registration number: NCT04837781).
... In the UK Biobank, 55% of participants had serum 25(OH)D concentrations < 50 nmol/L, with 13% < 25 nmol/L. 55 As participants in the UK Biobank in general are healthier than the general public, 56 the true prevalence of low vitamin D status in the UK population is likely to be higher. Given low vitamin D status is common around the world, our findings have significant public health implications. ...
Aims
Low vitamin D status is associated with a higher risk for cardiovascular diseases (CVDs). Although most existing linear Mendelian randomization (MR) studies reported a null effect of vitamin D on CVD risk, a non-linear effect cannot be excluded. Our aim was to apply the non-linear MR design to investigate the association of serum 25-hydroxyvitamin D [25(OH)D] concentration with CVD risk.
Methods and results
The non-linear MR analysis was conducted in the UK Biobank with 44 519 CVD cases and 251 269 controls. Blood pressure (BP) and cardiac-imaging-derived phenotypes were included as secondary outcomes. Serum 25(OH)D concentration was instrumented using 35 confirmed genome-wide significant variants.
We also estimated the potential reduction in CVD incidence attributable to correction of low vitamin D status. There was a L-shaped association between genetically predicted serum 25(OH)D and CVD risk (Pnon-linear = 0.007), where CVD risk initially decreased steeply with increasing concentrations and levelled off at around 50 nmol/L. A similar association was seen for systolic (Pnon-linear = 0.03) and diastolic (Pnon-linear = 0.07) BP. No evidence of association was seen for cardiac-imaging phenotypes (P = 0.05 for all). Correction of serum 25(OH)D level below 50 nmol/L was predicted to result in a 4.4% reduction in CVD incidence (95% confidence interval: 1.8–
7.3%).
Conclusion
Vitamin D deficiency can increase the risk of CVD. Burden of CVD could be reduced by population-wide correction of low vitamin D status.
... Major depressive disorder (MDD) is the leading cause of disability globally affecting 4.7% of the population [1]. Vitamin D deficiency is a major global health problem [2] and in the UK rates of both vitamin D deficiency and insufficiency are considerable [3]. Vitamin D is considered essential for bone health and immune function [4], but is also thought to affect the expression of certain neurotransmitters. ...
Observational evidence has implicated vitamin D levels as a risk factor in major depressive disorder (MDD). Confounding or reverse causation may be driving these observed associations, with studies using genetics indicating little evidence of an effect. However, genetic studies have relied on broad definitions of depression. The genetic architecture of different depression subtypes may vary since MDD is a highly heterogenous condition, implying potentially diverging requirements in therapeutic approaches. We explored the associations between vitamin D and two subtypes of MDD, for which evidence of a causal link could have the greatest clinical benefits: treatment-resistant depression (TRD) and atypical depression (AD). We used a dual approach, combining observational data with genetic evidence from polygenic risk scores (PRS) and two-sample Mendelian randomization (MR), in the UK Biobank. There was some evidence of a weak association between vitamin D and both incident TRD (Ncases = 830) and AD (Ncases = 2366) in observational analyses, which largely attenuated when adjusting for confounders. Genetic evidence from PRS and two-sample MR, did not support a causal link between vitamin D and either TRD (Ncases = 1891, OR = 1.01 [95%CI 0.78, 1.31]) or AD (Ncases = 2101, OR = 1.04 [95%CI 0.80, 1.36]). Our comprehensive investigations indicated some evidence of an association between vitamin D and TRD/AD observationally, but little evidence of association when using PRS and MR, mirroring findings of genetic studies of vitamin D on broad depression phenotypes. Results do not support further clinical trials of vitamin D in these MDD subtypes but do not rule out that small effects may exist that require larger samples to detect.
... This is despite a continuous debate since April 2020 about Vitamin D deficiency contributing to excess deaths in the BAME community (https://www.gov.uk/government/publications/covid-19-understanding-the-impacton-bame-communities). Throughout the year, the BAME community are known to have 20% less circulating vitamin-D (33) and even in summer more than 30% have severe deficiency compared to less than 6% in white European population (34) and probably have done so for many of the years since birth. In addition, there are two studies, one a randomized trial, that have clearly demonstrated that they need 10 times more Vitamin D than recommended in the SACN report (35,36). ...
Background: Reports early in the epidemic linking low mean national Vitamin D level with increased COVID-19 death, and until recently little research on the impact of Vitamin-D deficiency on severity of COVID-19, led to this update of the initial report studying mortality up to the end of January 2021.
Methods: Coronavirus pandemic data for 19 European countries were downloaded from Our World in Data, which was last updated on January 24, 2021. Data from March 21, 2020 to January 22, 2021 were included in the statistical analysis. Vitamin-D (25)-HD mean data were collected by literature review. Poisson mixed-effect model was used to model the data.
Results: European countries with Vitamin-D (25)-HD mean less than or equal to 50 have higher COVID-19 death rates as compared with European countries with Vitamin-D (25)-HD mean greater than 50, relative risk of 2.155 (95% CI: 1.068 - 4.347, p-value = 0.032). A statistically significant negative moderate Spearman rank correlation was observed between Vitamin-D (25)-HD mean and the number of COVID-19 deaths for each 14-day period during the COVID-19 pandemic time period.
Conclusions: The observation of the significantly lower COVID-19 mortality rates in countries with lowest annual sun exposure but highest mean Vitamin-D (25)-HD levels provides support for the use of food fortification. The need to consider re-configuring vaccine strategy due to emergence of large number of COVID-19 variants provides an opportunity to undertake such therapeutic randomized control trials.
... Interestingly we also observed that all MIS-C patients on our study were deficient for vitamin D, which is linked to greater disease severity in KD (Stagi et al., 2016;Jun et al., 2017) and enhanced inflammation in general (Yin and Agrawal, 2014). In the UK vitamin D deficiency is common in the black and ethnic minority groups, which 15/16 of our MIS-C patients were from (Sutherland et al., 2020). We therefore suggest it is unlikely that vitamin D deficiency alone is responsible for the development of MIS-C but, given the wide-ranging effects of vitamin D on the immune system (Feketea et al., 2021), this finding warrants further investigation in larger MIS-C cohorts. ...
Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening disease occurring several weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Deep immune profiling showed acute MIS-C patients had highly activated neutrophils, classical monocytes and memory CD8+ T-cells; increased frequencies of B-cell plasmablasts and double-negative B-cells. Post treatment samples from the same patients, taken during symptom resolution, identified recovery-associated immune features including increased monocyte CD163 levels, emergence of a new population of immature neutrophils and, in some patients, transiently increased plasma arginase. Plasma profiling identified multiple features shared by MIS-C, Kawasaki Disease and COVID-19 and that therapeutic inhibition of IL6 may be preferable to IL1 or TNF-α . We identified several potential mechanisms of action for IVIG, the most commonly used drug to treat MIS-C. Finally, we showed systemic complement activation with high plasma C5b-9 levels is common in MIS-C suggesting complement inhibitors could be used to treat the disease.
... However, other clinical subpopulations such as those with obesity are also at greater risk of vitamin D deficiency [110], and this risk can be increased due to race [108]. Indeed, similar trends exist in the UK, where those of Asian ancestry (57% in winter/spring versus 50% in summer/autumn), Black African ancestry (39% versus 31%), mixed ancestry (37% versus 23%), and Chinese ancestry (33% and 21%) were more likely to be vitamin D deficient than those from White European ancestry (18% versus 5.9%) [111]. Notably, vitamin D deficiency affects 1 in 5 living in Africa [112]. ...
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel contagion that has infected over 113 million people worldwide. It is responsible for the coronavirus disease (COVID-19), which has cost the lives of 2.5 million people. Ergo, the global scientific community has been scrambling to repurpose or develop therapeutics to treat COVID-19. Dietary supplements and nutraceuticals are among those under consideration due to the link between nutritional status and patient outcomes. Overall, poor vitamin D status seems to be associated with an increased risk of COVID-19. Severely ill COVID-19 patients appear to be deficient or have suboptimal levels of serum 25-hydroxyvitamin D, a measure of vitamin D status. Consequently, vitamin D is now the subject of several prophylactic and therapeutic clinical trials. In this review, the general status of nutraceuticals and dietary supplements amid the pandemic is appraised, with a particular focus on vitamin D. Consumers should be aware of misinformation and unsubstantiated promises for products marketed for COVID-19 protection. However, maintaining a healthy diet and lifestyle will likely maintain health including optimum immune function that may affect patient outcomes. Those who are deficient in key nutrients such as vitamin D should consider lifestyle changes and potentially supplementation in consultation with their physician and/or registered dieticians.
The relationship between the vitamin D receptor (VDR) gene and many pathogenic pathways in relapsing-remitting multiple sclerosis (RRMS) remains unclear. Given the significance of the topic, we conducted this study to explore the correlation between vitamin D receptor gene polymorphisms and clinical and inflammatory factors in patients suffering from relapsing-remitting multiple sclerosis. The current research is a case/control study conducted based on the Helsinki Ethical Principles. RRMS disease was confirmed based on history, clinical symptoms, radiological signs and neurologist diagnosis. The research population consisted of healthy people and patients with RRMS who were referred to Hazrat Rasool Akram Hospital between 2021 and 2023. For each person participating in the study (RRMS patient and healthy), five milliliters of peripheral blood containing the anticoagulant EDTA was collected. Polymerase chain reaction was performed using two specific and appropriate oligonucleotide primers. The restriction fragment length polymorphism technique was used, one of the standard methods for identifying polymorphisms. Statistical analysis was performed using SPSS software version 23. The odds ratio and 95% confidence limits were calculated. The SNP Analyzer software was used to analyze the allele frequency of each polymorphism in healthy and RRMS individuals and compare the values. Prism version 5 software was used to draw diagrams. In the present study, a statistically significant difference was observed between the percentage of FokI genotypes in RRMS patients and healthy individuals. FokI polymorphism showed a significantly increased risk with an odds ratio of 7.28 in patients with the FF genotype compared to healthy individuals. ApaI, TaqI, and BsmI were not significantly different between the two groups. Based on the findings of the present study, FokI polymorphism showed a significant risk increase in RRMS patients with FF genotype compared to healthy individuals.
Nanotechnology plays a pivotal role in food science, particularly in the nanoencapsulation of bioactive compounds, to enhance their stability, bioavailability, and therapeutic potential. This review aims to provide a comprehensive analysis of the encapsulation of bioactive compounds, emphasizing the characteristics, food applications, and implications for human health. This work offers a detailed comparison of polymers such as sodium alginate, gum Arabic, chitosan, cellulose, pectin, shellac, and xanthan gum, while also examining both conventional and emerging encapsulation techniques, including freeze-drying, spray-drying, extrusion, coacervation, and supercritical anti-solvent drying. The contribution of this review lies in highlighting the role of encapsulation in improving system stability, controlling release rates, maintaining bioactivity under extreme conditions, and reducing lipid oxidation. Furthermore, it explores recent technological advances aimed at optimizing encapsulation processes for targeted therapies and functional foods. The findings underline the significant potential of encapsulation not only in food supplements and functional foods but also in supportive medical treatments, showcasing its relevance to improving human health in various contexts.
A study into the determinants influencing Vitamin D supplementation among women of Bengali descent in the UK
Background
The prevalence of Vitamin D deficiency is widespread, particularly among South Asian women residing in temperate climates such as the United Kingdom. Contributory factors encompass dietary habits and conservative dressing practices.
Aims
This study aims to delineate the knowledge, perceptions, and determinants influencing Vitamin D supplementation among women of Bengali descent in the UK.
Methods
The study employed semi-structured interviews with women of Bengali origin at a general practice in London. A deductive thematic analysis was conducted utilizing the COM-B model to identify behavioural determinants. The study was approved by the Health Research Authority.
Findings
Key determinants to behaviours associated with Vitamin D supplementation encompassed awareness, cultural practices, healthcare advice, and personal convictions. Notwithstanding awareness of its criticality, actual intake was minimal due to factors like forgetfulness, cultural norms, and perceptions regarding the necessity of supplementation.
Conclusion
Although there is an overarching recognition of the significance of Vitamin D, adherence to supplementation regimens remains erratic. This study underscores the imperative for tailored health interventions that account for these elements to enhance Vitamin D supplementation among high-risk populations.
Background
Vitamin D deficiency is strongly associated with the development of several diseases. In the current context of a global pandemic of vitamin D deficiency, it is critical to identify people at high risk of vitamin D deficiency. There are no prediction tools for predicting the risk of vitamin D deficiency in the general community population, and this study aims to use machine learning to predict the risk of vitamin D deficiency using data that can be obtained through simple interviews in the community.
Methods
The National Health and Nutrition Examination Survey 2001-2018 dataset is used for the analysis which is randomly divided into training and validation sets in the ratio of 70:30. GBM, LR, NNet, RF, SVM, XGBoost methods are used to construct the models and their performance is evaluated. The best performed model was interpreted using the SHAP value and further development of the online web calculator.
Results
There were 62,919 participants enrolled in the study, and all participants included in the study were 2 years old and above, of which 20,204 (32.1%) participants had vitamin D deficiency. The models constructed by each method were evaluated using AUC as the primary evaluation statistic and ACC, PPV, NPV, SEN, SPE, F1 score, MCC, Kappa, and Brier score as secondary evaluation statistics. Finally, the XGBoost-based model has the best and near-perfect performance. The summary plot of SHAP values shows that the top three important features for this model are race, age, and BMI. An online web calculator based on this model can easily and quickly predict the risk of vitamin D deficiency.
Conclusion
In this study, the XGBoost-based prediction tool performs flawlessly and is highly accurate in predicting the risk of vitamin D deficiency in community populations.
Type 2 diabetes prevalence is increasing, reaching ‘pandemic’ proportions globally, and associated with increasing obesity rates. Concomitantly, vitamin D deficiency persists world-wide and is worsened by obesity because it reduces hepatic 25-hydroxylation of vitamin D, which reduces circulating 25(OH)D availability to target tissues; these include islet beta cells, since vitamin D is essential for adequate insulin responses to hyperglycemia. Increased insulin resistance increases type-2 diabetes risks and precedes its development by decades, reflecting changes in hepatic and muscle function that are corrected experimentally by activated hormonal vitamin D [calcitriol]; similarly, abnormal insulin resistance can be corrected in humans by correcting vitamin D deficiency using oral supplementation. Since vitamin D deficiency and inadequacy persist world-wide despite various guidelines on vitamin D intake, the possibility that correcting deficiency would contribute to reducing T2DM risks through beneficial effects on pancreatic islet beta cells and on the metabolic disorders contributing to insulin resistance through vitamin D inadequacy warrants consideration. If this is the case, then ensuring vitamin D adequacy in populations at high risk of Type-2 diabetes would be a valuable adjunct to other measures being taken to reduce that risk such as increased exercise and weight reduction. It would also reduce cardiovascular disease risks, well known to increase with insulin resistance, with or without concomitant Type-2 diabetes. Cardiovascular disease risks themselves can be reduced by adequately correcting deficiency and are lower with higher lifetime circulating 25-hydroxyvitamin D in deficient subjects from Mendelian randomization analysis. This report, therefore, reviews the evidence for increased insulin resistance as a risk factor for Type-2 diabetes, the beneficial effects of correcting vitamin deficiency on insulin resistance, Type-2 diabetes and cardiovascular risks, some basic mechanisms accounting for those benefits, the reasons for the persistence of vitamin D inadequacy globally and how best that problem could be corrected.
High vitamin D deficiency rates, with rickets and osteomalacia, have been common in South Asians (SAs) arriving in Britain since the 1950s with pre ventable infant deaths from hypocalcaemic status-epilepticus and cardiomyopathy. Vitamin D deficiency increases common SA disorders (type 2 diabetes and cardiovascular disease ), recent trials and non-linear Mendelian randomisation studies having shown deficiency t o be causal for both disorders. Ethnic minority, obesity, diabetes and social depriv ation are recognised COVID- 19 risk factors, but vitamin D deficiency is not, despite convin cing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitam in D deficiency in COVID-19 risk prediction, but both factors lower serum 25(OH)D specifical ly. Social deprivation inadequately explains increased ethnic minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using ‘educat ion’, ‘assimilation’ and ‘diet’ as ‘proxies’ for ethnic differences and increasing pressu res to assimilate. Meanwhile, English rickets was abolished from ~1940 by free ‘welfare foods ’ (meat, milk, eggs, cod liver oil), for all pregnant/nursing mothers and young children (
Purpose
Vitamin D deficiency is prevalent worldwide. This paper aims to investigate the vitamin D status and dietary intake in young university students.
Design/methodology/approach
Forty-one healthy students aged 18–29 years from Coventry University UK were recruited during January-February 2019, including white Caucasians (n = 18), African-Caribbeans (n = 14) and Asians (n = 9). Plasma 25(OH)D concentrations were measured and dietary vitamin D intake was determined. Chi-square and simple linear regression were used to analyse the data.
Findings
The plasma 25(OH)D concentrations were (36.0 ± 22.2) nmol/L in all subjects, (46.5 ± 25.3) nmol/L in white Caucasians, (22.6 ± 7.4) nmol/L in African-Caribbeans and (37.4 ± 21.7 nmol/L) in Asians. The majority (85.7%) of African-Caribbeans were vitamin D deficient compared with 22.2% of white Caucasians and 33.3% of Asians ( p = 0.001). Overweight/obese subjects showed a significant higher proportion of vitamin D deficiency (65%) than normal weight subjects (28.6%) ( p = 0.04). The average dietary vitamin D intake in all subjects was (4.6 ± 3.9) µg/day. Only 12.1% of the subjects met the recommended dietary vitamin D intake of 10 µg/day. Dietary vitamin D intake ( p = 0.04) and ethnicity ( p = 0.01) were significant predictors of 25(OH)D levels and accounted for 13% and 18.5% of 25(OH)D variance, respectively.
Research limitations/implications
This small-scale study showed an alarmingly high prevalence of vitamin D deficiency among subjects from African-Caribbean origin during wintertime. Education programs and campaigns are urgently needed to fight the vitamin D deficiency in this population.
Originality/value
The targeted population were in a critical period of transition from adolescence toward adulthood involving in changes in behaviours and nutrition.
Malnutrition in critical care is highly prevalent and well documented to have adverse implications on morbidity and mortality. During the current COVID-19 pandemic, the evolving literature has been able to identify high risk groups in whom unfavourable outcomes are more common, for example, obesity, premorbid status, male sex, members from the Black, Asian and Minority Ethnic (BAME) community and others. Nutritional status and provision precritical and pericritical phase of COVID-19 illness is gaining traction in the literature assessing how this can influence the clinical course. It is therefore of importance to understand and address the challenges present in critical care nutrition and to identify and mitigate factors contributing to malnutrition specific to this patient group. We report a case of significant disease burden and the associated cachexia and evidence of malnutrition in a young 36-year-old male with Somalian heritage with no pre-existing medical conditions but presenting with severe COVID-19 during the first wave of the pandemic (March 2020). We highlight some key nutritional challenges during the critical phase of illness signposting to some of the management instigated to counter this. These considerations are hoped to provide further insight to help continue to evolve nutritional management when treating patients with COVID-19.
Since first described almost a century ago, vitamin D preparations have been successfully used as a public health intervention to prevent nutritional rickets. In this manuscript, we document the periods in history when nutritional rickets was described, examine early efforts to understand its etiology and the steps taken to treat and prevent it. We will also highlight that despite the wealth of historical data and multiple preventative strategies, nutritional rickets remains a significant public health disorder. Nutritional rickets has both skeletal and extraskeletal manifestations. While the skeletal manifestations are the most recognized features, it is the extraskeletal complications, hypocalcaemic seizure and cardiomyopathy that are the most devastating features and result in reported fatalities. Reviewing this history provides an opportunity to further promote recent global consensus recommendations for the prevention and management of nutritional rickets, as well as gain a greater understanding of the well-known public health measures that can be used to manage this entirely preventable disease.
Background:
Vitamin D deficiency (VDD) affects the health and wellbeing of millions worldwide. In high latitude countries such as the United Kingdom (UK), severe complications disproportionally affect ethnic minority groups.
Objective:
To develop a decision-analytic model to estimate the cost effectiveness of population strategies to prevent VDD.
Methods:
An individual-level simulation model was used to compare: (I) wheat flour fortification; (II) supplementation of at-risk groups; and (III) combined flour fortification and supplementation; with (IV) a 'no additional intervention' scenario, reflecting the current Vitamin D policy in the UK. We simulated the whole population over 90 years. Data from national nutrition surveys were used to estimate the risk of deficiency under the alternative scenarios. Costs incurred by the health care sector, the government, local authorities, and the general public were considered. Results were expressed as total cost and effect of each strategy, and as the cost per 'prevented case of VDD' and the 'cost per Quality Adjusted Life Year (QALY)'.
Results:
Wheat flour fortification was cost saving as its costs were more than offset by the cost savings from preventing VDD. The combination of supplementation and fortification was cost effective (£9.5 per QALY gained). The model estimated that wheat flour fortification alone would result in 25% fewer cases of VDD, while the combined strategy would reduce the number of cases by a further 8%.
Conclusion:
There is a strong economic case for fortifying wheat flour with Vitamin D, alone or in combination with targeted vitamin D3 supplementation.
Vitamin D testing and treatment is subject of controversial scientific discussions and it is challenging to navigate through the expanding vitamin D literature with heterogeneous and partially opposed opinions and recommendations. In this narrative review, we aim to provide an update on vitamin D guidelines and the current evidence on the role of vitamin D for human health with its subsequent implications for patient care and public health issues. Vitamin D is critical for bone and mineral metabolism, and it is established that vitamin D deficiency can cause rickets and osteomalacia. While many guidelines recommend target serum 25-hydroxyvitamin D (25[OH]D) concentrations of ≥ 50 nmol/L (20 ng/mL), the minimum consensus in the scientific community is that serum 25(OH)D concentrations below 25 to 30 nmol/L (10 to 12 ng/mL) must be prevented and treated. Using this latter threshold of serum 25(OH)D concentrations, it has been documented that there is a high worldwide prevalence of vitamin D deficiency that may require public health actions such as vitamin D food fortification. On the other hand, there is also reason for concern that an exploding rate of vitamin D testing and supplementation increases costs and might potentially be harmful. In the scientific debate on vitamin D we should consider that nutrient trials differ from drug trials and that apart from the opposed positions regarding indications for vitamin D treatment we still have to better characterize the precise role of vitamin D for human health.
There has recently been a huge number of publications concerning various aspects of vitamin D, from the physiological to therapeutic fields. However, as a consequence of this very fast-growing scientific area, some issues still remain surrounded by uncertainties, without a final agreement having been reached. Examples include the definitions of vitamin D sufficiency and insufficiency, (i.e., 20 vs. 30 ng/mL), the relationship between 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, (i.e., linear vs. no linear), the referent to consider, (i.e., total vs. free determination), the utility of screening versus universal supplementation, and so on. In this review, the issues related to vitamin D supplementation in subjects with documented hypovitaminosis, and the role of vitamin D in cancer will be concisely considered. Daily, weekly, or monthly administration of cholecalciferol generally leads to essentially similar results in terms of an increase in 25(OH)D serum levels. However, we should also consider possible differences related to a number of variables, (i.e., efficiency of intestinal absorption, binding to vitamin D binding protein, and so on). Thus, adherence to therapy may be more important than the dose regimen chosen in order to allow long-term compliance in a sometimes very old population already swamped by many drugs. It is difficult to draw firm conclusions at present regarding the relationship between cancer and vitamin D. In vitro and preclinical studies seem to have been more convincing than clinical investigations. Positive results in human studies have been mainly derived from post-hoc analyses, secondary end-points or meta-analyses, with the last showing not a decrease in cancer incidence but rather in mortality. We must therefore proceed with a word of caution. Until it has been clearly demonstrated that there is a causal relationship, these positive “non-primary, end-point results” should be considered as a background for generating new hypotheses for future investigations.
Background:
The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England.
Methods:
Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data.
Results:
In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and third priorities. Workshop 3 did not diverge from findings in Round 1.
Conclusions:
Practice professionals and academics agreed that reducing health inequalities in the North of England requires prioritizing research that tackles structural determinants concerning poverty, the implications of austerity measures and unemployment.
Fluid milk products are systematically, either mandatorily or voluntarily, fortified with vitamin D in some countries but their overall contribution to vitamin D intake and status worldwide is not fully understood. We searched the PubMed database to evaluate the contribution of vitamin D-fortified fluid milk products (regular milk and fermented products) to vitamin D intake and serum or plasma 25-hydroxyvitamin D (25(OH)D) status in observational studies during 1993–2017. Twenty studies provided data on 25(OH)D status (n = 19,744), and 22 provided data on vitamin D intake (n = 99,023). Studies showed positive associations between the consumption of vitamin D-fortified milk and 25(OH)D status in different population groups. In countries with a national vitamin D fortification policy covering various fluid milk products (Finland, Canada, United States), milk products contributed 28–63% to vitamin D intake, while in countries without a fortification policy, or when the fortification covered only some dairy products (Sweden, Norway), the contribution was much lower or negligible. To conclude, based on the reviewed observational studies, vitamin D-fortified fluid milk products contribute to vitamin D intake and 25(OH)D status. However, their impact on vitamin D intake at the population level depends on whether vitamin D fortification is systematic and policy-based.
Importance
The role of tobacco-smoke exposure on serum vitamin D concentration in US pediatric population is not known. We hypothesized that tobacco smoke exposure would increase the prevalence of vitamin D deficiency in US children.
Methods
Representative national data were accessed from the National Health and Nutrition Examination Survey (NHANES) 2009–2010 databank on 2,263 subjects of ages 3 to 17 years. Subjects were categorized into two groups based on their age: children, if <10 years; and youth if 10 to 17 years. Descriptive and multiple logistic regression analyses were conducted to determine the effect of serum cotinine-verified tobacco smoke exposure on vitamin D status after controlling for key sociodemographic confounders. Vitamin D deficiency was defined as 25(OH)D <20 ng/mL, insufficiency as 25(OH)D of 20–29.9 ng/mL, and sufficiency as 25(OH)D of ≥30 ng/mL. Tobacco smoke exposure status was defined by serum cotinine concentration as follows: unexposed and non-smoking (<0.05 ng/mL) and exposed (passive and active smokers combined) (≥0.05ng/mL). Specifically, passive and active smoking were defined as cotinine of 0.05–10 ng/mL, and ≥10ng/mL respectively.
Results
The prevalence of second-hand smoke exposure was 42.0% (95%CI, 36.7%-47.5%); while the prevalence of active smoking among teenagers was 9.0% (95%CI, 6.2%-12.5%). Vitamin D deficiency occurred at a frequency of 15.1% in children unexposed to tobacco smoke, 20.9% in children exposed to passive tobacco smoke, and 18.0% among actively smoking youth (p<0.001). Tobacco smoke exposure independently predicted vitamin D deficiency after controlling for age, sex, race, BMI, maternal education, and family socio-economic status (OR:1.50; 95%CI, 1.14–1.85, p = 0.002).
Conclusions
This analysis of a nationwide database reports that tobacco smoke exposure is an independent predictor of vitamin D deficiency in US children.
Abstract Background Whilst hypocalcemic complications from vitamin D deficiency are considered rare in high-income countries, they are highly prevalent among Black, Asian and Minority Ethnic (BAME) group with darker skin. To date, the extent of osteomalacia in such infants and their family members is unknown. Our aim was to investigate clinical, cardiac and bone histomorphometric characteristics, bone matrix mineralization in affected infants and to test family members for biochemical evidence of osteomalacia. Case presentation Three infants of BAME origin (aged 5–6 months) presented acutely in early-spring with cardiac arrest, respiratory arrest following seizure or severe respiratory distress, with profound hypocalcemia (serum calcium 1.22–1.96 mmol/L). All infants had dark skin and vitamin D supplementation had not been addressed during child surveillance visits. All three had severely dilated left ventricles (z-scores + 4.6 to + 6.5) with reduced ejection fraction (25–30%; normal 55–70), fractional shortening (7 to 15%; normal 29–40) and global hypokinesia, confirming hypocalcemic dilated cardiomyopathy. They all had low serum levels of 25 hydroxyvitamin D (25OHD
Background
Disparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems. Methods
In this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions. ResultsOverall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care. ConclusionA greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vulnerable groups. The cumulative nature of these barriers remains to be assessed.
Background:
Nutritional rickets is a growing global public health concern despite existing prevention programs and health policies. We aimed to compare infant and childhood vitamin D supplementation policies, implementation strategies and practices across Europe and explore factors influencing adherence.
Methods:
European Society for Paediatric Endocrinology Bone and Growth Plate Working Group members and other specialists completed a questionnaire on country-specific vitamin D supplementation policy and child healthcare programs, socioeconomic factors, policy implementation strategies, and adherence. Factors influencing adherence were assessed using Kendall's tau-b correlation coefficient.
Results:
Responses were received from 29 of 30 European countries (97%). Ninety-six per cent had national policies for infant vitamin D supplementation. Supplements are commenced on day 1-5 in 48% (14/29) of countries, day 6-21 in 48% (14/29); only the UK (1/29) starts supplements at 6 months. Duration of supplementation varied widely (6 months to lifelong in at-risk populations). Good (≥80% of infants), moderate (50-79%) and low adherence (<50%) to supplements was reported by 59% (17/29), 31% (9/29) and 10% (3/29) of countries, respectively. UK reported lowest adherence (5-20%). Factors significantly associated with good adherence were universal supplementation independent of feeding mode (p=0.007), providing information at neonatal unit (NNU) discharge (p=0.02), financial family support (p=0.005); monitoring adherence at surveillance visits (p=0.001) and the total number of factors adopted (p<0.001).
Conclusions:
Good adherence to supplementation is a multi-task operation that works best when parents are informed at birth, all babies are supplemented and adherence monitoring is incorporated into child health surveillance visits. Implementation strategies matter for delivering efficient prevention policies.
Vitamin D deficiency has been identified as a common metabolic/endocrine abnormality. Despite known dietary sources of vitamin D and the role of sunlight in its production, much of the US population may have inadequate levels of serum 25-hydroxyvitamin D. Deficiency of vitamin D can be caused by a variety of health conditions, but studies on the effects of vitamin D supplements have had mixed results. This evidence-based clinical review discusses what is currently known about vitamin D and what areas need further research to clarify its role in health and disease.
The human requirement for vitamin D is achieved primarily through the synthesis of this prehormone in the skin during exposure to ultraviolet B (UVB) radiation, with only a minor contribution from the diet, year round. Achieving optimal vitamin D status is therefore largely dependent upon adequate exposure of the skin to sunlight, however, the length of exposure required varies with latitude and season, and is also dependent upon skin pigmentation, with darker skin requiring greater exposure than fair skin due to the protective effects of melanin against UVB radiation. In northern European latitudes, where UVB radiation between the months of October and March is of insufficient intensity for the synthesis of vitamin D via this route, vitamin D deficiency is a public health concern, particularly for south Asian diaspora and other dark-skinned ethnic minority communities. The consequences of vitamin D deficiency include poor bone health, including rickets and osteomalacia. In addition, there is increasing awareness of an important role for vitamin D in the development and progression of chronic diseases, including type 2 diabetes, which is prevalent in south Asian populations. The aim of this review is to examine some of the most recent reports of vitamin D status in south Asian diaspora communities, and to explore its impact on bone health. In addition, we will examine the putative association between type 2 diabetes and vitamin D deficiency in south Asian populations and the current guidelines for treatment of vitamin D deficiency of south Asians in primary care settings.
The vitamin D receptor (VDR) is found in nearly all, if not all, cells in the body. The enzyme that produces the active metabolite of vitamin D and ligand for VDR, namely CYP27B1, likewise is widely expressed in many cells of the body. These observations indicate that the role of vitamin D is not limited to regulation of bone and mineral homeostasis, as important as that is. Rather, the study of its extraskeletal actions has become the major driving force behind the significant increase in research articles on vitamin D published over the past several decades. A great deal of information has accumulated from cell culture studies, in vivo animal studies, and clinical association studies that confirms that extraskeletal effects of vitamin D are truly widespread and substantial. However, randomized, placebo-controlled clinical trials, when done, have by and large not produced the benefits anticipated by the in vitro cell culture and in vivo animal studies. In this review, I will examine the role of vitamin D signaling in a number of extraskeletal tissues and assess the success of translating these findings into treatments of human diseases affecting those extracellular tissues.
Vitamin D is vital for musculoskeletal health and has been associated with protection against several internal cancers and auto-immune diseases. Skin synthesis following exposure to ultraviolet radiation (UVR) in sunlight is the major source of the vitamin, with diet providing only small amounts. Skin synthesis requires sunlight exposure containing sufficient UVB to initiate vitamin D synthesis, which precludes the winter months at mid-high latitudes, including the UK. This article is protected by copyright. All rights reserved.
Given previous evidence that not all Scotland's higher mortality compared to England & Wales (E&W) can be explained by deprivation, the aim was to enhance understanding of this excess by analysing changes in deprivation and mortality in Scotland and E&W between 1981 and 2011. Mortality was compared by means of direct standardisation and log-linear Poisson regression models, adjusting for age, sex and deprivation. Different measures of deprivation were employed, calculated at different spatial scales. Results show that Scotland became less deprived compared to E&W between 1981 and 2011. However, the Scottish excess (the difference in mortality rates relative to E&W after adjustment for deprivation) increased from 4% higher (c.1981) to 10% higher in 2010–12. The latter figure equates to c. 5000 extra deaths per year. The increase was driven by higher mortality from cancer, suicide, alcohol related causes and drugs-related poisonings. The size and increase in Scottish excess mortality are major concerns. Investigations into its underlying causes continue, the findings of which will be relevant to other populations, given that similar excesses have been observed elsewhere in Britain.
Background:
It is well known that fish is the major natural source of vitamin D in the diet; therefore, this meta-analysis investigated the influence of fish consumption in randomized controlled trials (RCTs) on serum 25-hydroxyvitamin D [25(OH)D] concentrations.
Objective:
A literature search was carried out in Medline, Embase, Web of Science, and the Cochrane Library (up to February 2014) for RCTs that investigated the effect of fish consumption on 25(OH)D concentrations in comparison to other dietary interventions.
Results:
Seven articles and 2 unpublished study data sets with 640 subjects and 14 study groups met the inclusion criteria and were included in this meta-analysis. Compared with controls, the consumption of fish increased 25(OH)D concentrations, on average, by 4.4 nmol/L (95% CI: 1.7, 7.1 nmol/L; P < 0.0001, I(2) = 25%; 9 studies).The type of the fish also played a key role: the consumption of fatty fish resulted in a mean difference of 6.8 nmol/L (95% CI: 3.7, 9.9 nmol/L; P < 0.0001, I(2) = 0%; 7 study groups), whereas for lean fish the mean difference was 1.9 nmol/L (95% CI: -2.3, 6.0 nmol/L; P < 0.38, I(2) = 37%; 7 study groups). Short-term studies (4-8 wk) showed a mean difference of 3.8 nmol/L (95% CI: 0.6, 6.9 nmol/L; P < 0.02, I(2) = 38%; 10 study groups), whereas in long-term studies (∼6 mo) the mean difference was 8.3 nmol/L (95% CI: 2.1, 14.5 nmol/L; P < 0.009, I(2) = 0%; 4 study groups).
Conclusion:
As the major food source of vitamin D, fish consumption increases concentrations of 25(OH)D, although recommended fish intakes cannot optimize vitamin D status.
Vitamin D has known importance to bone health including calcium and phosphate homeostasis and appears to have a role in skeletal muscle health as well. Cases of vitamin D deficiency and insufficiency have been associated with poor muscle health. While the exact effects and mechanism of action remains controversial, current data lean towards insufficient vitamin D playing a role in musculoskeletal pain, sarcopenia, myopathy, falls and indirectly via cerebellar and cognitive dysfunction. Sophisticated experimental techniques have allowed detection of the vitamin D receptor (VDR) on skeletal muscle and cerebellar tissue, which if validated in further large studies, could confirm the mechanism of vitamin D in these associations. While further study is required, vitamin D repletion can have a substantial impact on muscle as well as bone health.
The body mass index (BMI) is the metric currently in use for defining anthropometric height/weight characteristics in adults and for classifying (categorizing) them into groups. The common interpretation is that it represents an index of an individual's fatness. It also is widely used as a risk factor for the development of or the prevalence of several health issues. In addition, it is widely used in determining public health policies.The BMI has been useful in population-based studies by virtue of its wide acceptance in defining specific categories of body mass as a health issue. However, it is increasingly clear that BMI is a rather poor indicator of percent of body fat. Importantly, the BMI also does not capture information on the mass of fat in different body sites. The latter is related not only to untoward health issues but to social issues as well. Lastly, current evidence indicates there is a wide range of BMIs over which mortality risk is modest, and this is age related. All of these issues are discussed in this brief review. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright
Cathie Sudlow and colleagues describe the UK Biobank, a large population-based prospective study, established to allow investigation of the genetic and non-genetic determinants of the diseases of middle and old age.
Interpretation of parathyroid hormone (iPTH) requires knowledge of vitamin D status that is influenced by season.
Characterize the temporal relationship between 25-hydroxyvitamin D3 levels [25(OH)D3] and intact iPTH for several seasons, by gender and latitude in the U.S. and relate 25-hydrovitamin D2 [25(OH)D2] levels with PTH levels and total 25(OH)D levels.
We retrospectively determined population weekly-mean concentrations of unpaired [25(OH)D2 and 25(OH)D3] and iPTH using 3.8 million laboratory results of adults. The 25(OH)D3 and iPTH distributions were normalized and the means fit with a sinusoidal function for both gender and latitudes: North >40, Central 32-40 and South <32 degrees. We analyzed PTH and total 25(OH)D separately in samples with detectable 25(OH)D2 (≥4 ng/mL).
Seasonal variation was observed for all genders and latitudes. 25(OH)D3 peaks occurred in September and troughs in March. iPTH levels showed an inverted pattern of peaks and troughs relative to 25(OH)D3, with a delay of 4 weeks. Vitamin D deficiency and insufficiency was common (33% <20 ng/mL; 60% <30 ng/mL) as was elevated iPTH levels (33%>65 pg/mL). The percentage of patients deficient in 25(OH)D3 seasonally varied from 21% to 48% and the percentage with elevated iPTH reciprocally varied from 28% to 38%. Patients with detectable 25(OH)D2 had higher PTH levels and 57% of the samples with a total 25(OH)D > 50 ng/mL had detectable 25(OH)D2.
25(OH)D3 and iPTH levels vary in a sinusoidal pattern throughout the year, even in vitamin D2 treated patients; 25(OH)D3, being higher in the summer and lower in the winter months, with iPTH showing the reverse pattern. A large percentage of the tested population showed vitamin D deficiency and secondary hyperparathyroidism. These observations held across three latitudinal regions, both genders, multiple-years, and in the presence or absence of detectable 25(OH)D2, and thus are applicable for patient care.
To test the hypothesis that genetically low 25-hydroxyvitamin D concentrations are associated with increased mortality.
Mendelian randomisation analysis.
Copenhagen City Heart Study, Copenhagen General Population Study, and Copenhagen Ischemic Heart Disease Study.
95 766 white participants of Danish descent from three cohorts, with median follow-up times of 19.1, 5.8, and 7.9 years, genotyped for genetic variants in DHCR7 and CYP2R1 affecting plasma 25-hydroxyvitamin D concentrations; 35 334 also had plasma 25-hydroxyvitamin D measurements. Participants were followed from study entry through 2013, during which time 10 349 died.
All cause mortality and cause specific mortality, adjusted for common risk factors for all cause mortality based on the World Health Organization's global health status.
The multivariable adjusted hazard ratios for a 20 nmol/L lower plasma 25-hydroxyvitamin D concentration were 1.19 (95% confidence interval 1.14 to 1.25) for all cause mortality, 1.18 (1.09 to 1.28) for cardiovascular mortality, 1.12 (1.03 to 1.22) for cancer mortality, and 1.27 (1.15 to 1.40) for other mortality. Each increase in DHCR7/CYP2R1 allele score was associated with a 1.9 nmol/L lower plasma 25-hydroxyvitamin D concentration and with increased all cause, cancer, and other mortality but not with cardiovascular mortality. The odds ratio for a genetically determined 20 nmol/L lower plasma 25-hydroxyvitamin D concentration was 1.30 (1.05 to 1.61) for all cause mortality, with a corresponding observational multivariable adjusted odds ratio of 1.21 (1.11 to 1.31). Corresponding genetic and observational odds ratios were 0.77 (0.55 to 1.08) and 1.13 (1.03 to 1.24) for cardiovascular mortality, 1.43 (1.02 to 1.99) and 1.10 (1.02 to 1.19) for cancer mortality, and 1.44 (1.01 to 2.04) and 1.17 (1.06 to 1.29) for other mortality. The results were robust in sensitivity analyses.
Genetically low 25-hydroxyvitamin D concentrations were associated with increased all cause mortality, cancer mortality, and other mortality but not with increased cardiovascular mortality. These findings are compatible with the notion that genetically low 25-hydroxyvitamin D concentrations may be causally associated with cancer and other mortality but also suggest that the observational association with cardiovascular mortality could be the result of confounding.
© Afzal et al 2014.
The North South divide in England has been a popular trope from the mid-19th century novels of Charles Dickens (Hard Times, 1854) and Elizabeth Gaskell (North and South, 1855) through to TV and radio documentaries of 2014.1,2 These often focus on culture and the economy, but it is also well known that there are large and longstanding geographical inequalities in health in England.3 Between 2009 and 2011 people in Manchester were more than twice as likely to die early (455 deaths per 100 000) as people living in Wokingham (200 deaths per 100 000).3 This sort of finding is not new; for the past four decades, the North of England (commonly defined as the North East, North West and Yorkshire and Humber regions) has persistently had higher all-cause mortality rates than the South of England, and the gap has widened over time.4 This dates back to at least the early 19th century when, for example, Chadwick5 found that life expectancy for all social classes was higher in Bath than in Liverpool.
The extent of the current spatial health divide in England is extreme by contemporary comparative standards. England has some of the largest regional inequalities in health in Europe (Fig. 1). The scale of the divide is such that the life expectancy gap for women between the poorest English regions—the North East (NE) and North West (NW)—and the richest—London and the South East—was similar to the gap between the former West Germany and post-communist East Germany in the mid-1990s (Fig. 2). What the history of German reunification shows is that these regional differences can be addressed. After reunification in 1990, life expectancy for women in East Germany caught up with that of women in West Germany in little more than a decade, whereas the gap between the North of England and London has persisted for women. East German women now have a higher life expectancy than NE English women. The German spatial life expectancy gap for men is now smaller than the English one.
How can we assess the reciprocal impacts of politics and medicine in the contemporary period? Using the example of rickets in twentieth century Britain, I will explore the ways in which a preventable, curable non-infectious disease came to have enormous political significance, first as a symbol of socioeconomic inequality, then as evidence of racial and ethnic health disparities. Between the 1920s and 1980s, clinicians, researchers, health workers, members of Parliament and later Britain's growing South Asian ethnic communities repeatedly confronted the British state with evidence of persistent nutritional deficiency among the British poor and British Asians. Drawing on bitter memories of the 'Hungry Thirties', postwar rickets-so often described as a 'Victorian' disease-became a high-profile sign of what was variously constructed as a failure of the Welfare State; or of the political parties charged with its protection; or of ethnically Asian migrants and their descendants to adapt to British life and norms. Here I will argue that rickets prompted such consternation not because of its severity, the cost of its treatment, or even its prevalence; but because of the ease with which it was politicised. I will explore the ways in which this condition was envisioned, defined and addressed as Britain moved from the postwar consensus to Thatcherism, and as Britain's diverse South Asian communities developed from migrant enclaves to settled multigenerational ethnic communities.
Long-standing concerns over vitamin D status of South Asian adults in the UK require studies using statistically valid sample sizes to measure annual variation and contributory lifestyle factors.
Measure annual variation in vitamin D status and determine associated lifestyle influences. Evaluate with respect to a similar study of white Caucasian adults.
A single-centre, prospective cohort study measuring circulating 25(OH)D, sunlight exposure levels and lifestyle factors for one year in 125 ambulant South Asian adults with sun-reactive skin type V, aged 20-60 years, in Greater-Manchester, UK (53.5°N).
The 25(OH)D levels of South Asians were alarmingly low. In summer, their median (IQR) 25(OH)D was 9.0(6·7-13·1)ng/mL (22·5nmol/L) falling to 5·8(4·0-8·1) ng/mL (14·5nmol/L) in winter. This compared to white Caucasian values of 26·2(19·9-31·5) ng/mL (65·5nmol/L) in summer and 18·9(11·6-23·8) ng/mL (47·2nmol/L) in winter. Median daily dietary vitamin D was lower in South Asians (1·32μg versus 3·26μg for white Caucasians) and compounded by low supplement use. Despite similar times spent outdoors, UV-dosimeters recorded lower personal UV exposure amongst South Asians, indicating sun avoidance when outside, while sun exposure diaries recorded lower amounts of skin surface exposure.
The majority of South Asians never reached sufficiency in vitamin D status. Lifestyle differences, with lower oral intake, sun exposure and rates of cutaneous production due to darker skin, indicate that standard advice on obtaining sufficient vitamin D needs modification for the South Asian community in UK. This article is protected by copyright. All rights reserved.
Vitamin D insufficiency affects almost 50% of the population worldwide. An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency (VDD). This pandemic of hypovitaminosis D can mainly be attributed to lifestyle (for example, reduced outdoor activities) and environmental (for example, air pollution) factors that reduce exposure to sunlight, which is required for ultraviolet-B (UVB)-induced vitamin D production in the skin. High prevalence of vitamin D insufficiency is a particularly important public health issue because hypovitaminosis D is an independent risk factor for total mortality in the general population. Current studies suggest that we may need more vitamin D than presently recommended to prevent chronic disease. As the number of people with VDD continues to increase, the importance of this hormone in overall health and the prevention of chronic diseases are at the forefront of research. VDD is very common in all age groups. As few foods contain vitamin D, guidelines recommended supplementation at suggested daily intake and tolerable upper limit levels. It is also suggested to measure the serum 25-hydroxyvitamin D level as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D2 or vitamin D3 is recommended for deficient patients. A meta-analysis published in 2007 showed that vitamin D supplementation was associated with significantly reduced mortality. In this review, we will summarize the mechanisms that are presumed to underlie the relationship between vitamin D and understand its biology and clinical implications.
Epidemiological and other evidence suggests that vitamin D may be protective against several chronic diseases. Assessing vitamin D status in epidemiological studies, however, is challenging given finite resources and limitations of commonly used approaches. Using multivariable linear regression, we derived predicted 25-hydroxyvitamin D (25(OH)D) scores based on known determinants of circulating 25(OH)D, including age, race, UV-B radiation flux at residence, dietary and supplementary vitamin D intakes, BMI, physical activity, alcohol intake, post-menopausal hormone use (women only) and season of blood draw, in three nationwide cohorts: the Nurses' Health Study, Nurses' Health Study II and the Health Professionals Follow-up Study. The model r2 for each cohort ranged from 0·25 to 0·33. We validated the prediction models in independent samples of participants from these studies. Mean measured 25(OH)D levels rose with increasing decile of predicted 25(OH)D score, such that the differences in mean measured 25(OH)D between the extreme deciles of predicted 25(OH)D were in the range 8·7-12·3 ng/ml. Substituting predicted 25(OH)D scores for measured 25(OH)D in a previously published case-control analysis of colorectal cancer yielded similar effect estimates with OR of approximately 0·8 for a 10 ng/ml difference in either plasma or predicted 25(OH)D. We conclude that these data provide reasonable evidence that a predicted 25(OH)D score is an acceptable marker for ranking individuals by long-term vitamin D status and may be particularly useful in research settings where biomarkers are not available for the majority of a study population.
The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency.
The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration.
Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes.
Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.
In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown.
We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000.
In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated. During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD. In multivariate models (adjusted for baseline demographics, season, and traditional and novel CVD risk factors), compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.
The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.
Vitamin D has steroid hormonal effects which can produce clinical symptoms and signs unrelated to calcium homoeostasis. Its deficiency has been implicated as a risk factor for diabetes, ischaemic heart disease, and tuberculosis in Asians. In this review, the incidence, aetiology, prevention, and treatment of symptomatic vitamin D deficiency in childhood are considered. A renewed public health campaign is required in the UK to address the continuing problem of vitamin D deficiency in Asian families.
The paper describes the creation of the Office for National Statistics 2001 output area classification, which was created in collaboration with the authors. The classification places each 2001 census output area into one of seven clusters based on the socio-economic attributes of the residents of each area. The classification uses cluster analysis to reduce 41 census variables to a single socio-economic indicator. The classification was made available with a host of supporting and descriptive information as a National Statistic via National Statistics on line. The classification forms part of a suite of area classifications that were produced by the Office for National Statistics from 2001 census data. Classifications of local authorities, statistical wards and health areas are also available. Copyright 2007 Royal Statistical Society.
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) < 50 nmol/l or 20 ng/ml), is common in Europe and the Middle East. It occurs in < 20 % of the population in Northern Europe, in 30-60% in Western, Southern and Eastern Europe and up to 80 % in Middle East countries. Severe deficiency (serum 25(OH)D < 30 nmol/l or 12 ng/ml) is found in > 10 % of Europeans. The ECTS advises that the measurement of serum 25(OH)D be standardized e.g. by the Vitamin D Standardization Program. Risk groups include young children, adolescents, pregnant women, older people, especially the institutionalized, and non-western immigrants. Consequences of vitamin D deficiency include mineralization defects and lower bone mineral density causing fractures. Extra-skeletal consequences may be muscle weakness, falls and acute respiratory infection, and are the subject of large ongoing clinical trials. The ECTS advises to improve vitamin D status by food fortification and the use of vitamin D supplements in risk groups. Fortification of foods by adding vitamin D to dairy products, bread and cereals can improve the vitamin D status of the whole population, but quality assurance monitoring is needed to prevent intoxication. Specific risk groups such as infants and children up to 3 years, pregnant women, older persons and non-western immigrants should routinely receive vitamin D supplements. Future research should include genetic studies to better define individual vulnerability for vitamin D deficiency, and Mendelian randomization studies to address the effect of vitamin D deficiency on long term non-skeletal outcomes such as cancer.
UK Biobank is a population-based cohort of 500,000 participants recruited between 2006 and 2010. Approximately 9.2 million individuals aged 40-69 years who lived within 25 miles of the 22 assessment centres in England, Wales and Scotland were invited, and 5.4% participated in the baseline assessment. The representativeness of the UK Biobank cohort was investigated by comparing demographic characteristics between non-responders and responders. Sociodemographic, physical, lifestyle and health-related characteristics of the cohort were compared with nationally representative data sources. UK Biobank participants were more likely to be older, women and to live in less socioeconomically deprived areas than non-participants. Compared with the general population, participants were less likely to be obese, smoke, drink alcohol on a daily basis and had fewer self-reported health outcomes. Rates of all-cause mortality and total cancer incidence (at age 70-74 years) were 46.2% and 11.8% lower in men, and 55.5% and 18.1% lower in women, respectively, than the general population of the same age. UK Biobank is not representative of the sampling population, with evidence of a 'healthy volunteer' selection bias. Nonetheless, the valid assessment of exposure-disease relationships may be widely generalizable and does not require participants to be representative of the population at large.
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According to the latest census, non-white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African-Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups.
As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well-designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups.
This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non-white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups.
It is well-established that prolonged and severe vitamin D deficiency leads to rickets in children and osteomalacia in adults. More marginal vitamin D deficiency is likely to be a significant contributing factor to osteoporosis risk. However, recent emerging data from studies of adults suggest that low vitamin D status (serum 25-hydroxyvitamin D levels <50 nmol/l) may be contributing to the development of various chronic diseases, including cardiovascular disease, hypertension, diabetes mellitus, some inflammatory and autoimmune diseases, and certain cancers. Adequacy of vitamin D status in children and adolescents has been the focus of a number of recent investigations, and these studies have shown a high prevalence of low vitamin D status during the winter (especially in adolescents), with lower prevalence during the summer. Therefore, consideration of potential corrective strategies to allow children and adolescents to maintain adequate vitamin D status throughout the year, even in the absence of adequate summer sun exposure, is warranted.
The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy.
Genome-wide association studies (GWASs) have been widely used to map loci contributing to variation in complex traits and risk of diseases in humans. Accurate specification of familial relationships is crucial for family-based GWAS, as well as in population-based GWAS with unknown (or unrecognized) family structure. The family structure in a GWAS should be routinely investigated using the SNP data prior to the analysis of population structure or phenotype. Existing algorithms for relationship inference have a major weakness of estimating allele frequencies at each SNP from the entire sample, under a strong assumption of homogeneous population structure. This assumption is often untenable.
Here, we present a rapid algorithm for relationship inference using high-throughput genotype data typical of GWAS that allows the presence of unknown population substructure. The relationship of any pair of individuals can be precisely inferred by robust estimation of their kinship coefficient, independent of sample composition or population structure (sample invariance). We present simulation experiments to demonstrate that the algorithm has sufficient power to provide reliable inference on millions of unrelated pairs and thousands of relative pairs (up to 3rd-degree relationships). Application of our robust algorithm to HapMap and GWAS datasets demonstrates that it performs properly even under extreme population stratification, while algorithms assuming a homogeneous population give systematically biased results. Our extremely efficient implementation performs relationship inference on millions of pairs of individuals in a matter of minutes, dozens of times faster than the most efficient existing algorithm known to us.
Our robust relationship inference algorithm is implemented in a freely available software package, KING, available for download at http://people.virginia.edu/∼wc9c/KING.
A competitive protein binding assay for 25-hydroxycholecalciferol (25-H.c.c.) has been used to study rickets and osteomalacia in Asian immigrants to Britain. Compared with levels in a Caucasian control group, serum-25-H.C.C. concentrations were significantly lower in a group of Asians with no clinical or biochemical evidence of rickets or osteomalacia, and were still lower in another group without clinical disease but with raised serum-alkaline-phosphatase concentrations. In a group with overt rickets or osteomalacia 25-H.C.C. was undetectable in all cases. It seems that vitamin-D deficiency is the major factor leading to rickets and osteomalacia in Indian and Pakistani immigrants to Britain.
Vitamin D production in human skin occurs only when incident UV radiation exceeds a certain threshold. From simulations of UV irradiances worldwide and throughout the year, we have studied the dependency of the extent and duration of cutaneous vitamin D production in terms of latitude, time, total ozone, clouds, aerosols, surface reflectivity and altitude. For clear atmospheric conditions, no cutaneous vitamin D production occurs at 51 degrees latitude and higher during some periods of the year. At 70 degrees latitude, vitamin D synthesis can be absent for 5 months. Clouds, aerosols and thick ozone events reduce the duration of vitamin D synthesis considerably, and can suppress vitamin D synthesis completely even at the equator. A web page allowing the computation of the duration of cutaneous vitamin D production worldwide throughout the year, for various atmospheric and surface conditions, is available on the Internet at http://zardoz.nilu.no/~olaeng/fastrt/VitD.html and http://zardoz.nilu.no/~olaeng/fastrt/VitD-ez.html. The computational methodology is outlined here.
Physical activity is an established risk factor for chronic disease but very little is known about its temporal trends in England. Such information is crucial for planning public health interventions.
We explored temporal trends in occupational activity, walking, domestic activity, and sports using Health Survey for England data in 95,342 adults aged 16 and over. Data were collected annually in 1991-4, 1997-9, and 2003-04. Multivariate logistic regression and multiple linear regression models assessed trends in physical activity for dichotomous and continuous outcomes, respectively. Analyses were adjusted for age and social class.
Physical activity levels at work declined over time but there was a consistent and significant upward trend in regular sports participation among all age groups. Changes in questions in 1997 and 1999 confounded trends in walking and heavy domestic activity and total physical activity. Between 1999 and 2004 (when physical activity questions remained unchanged), there were significant increases in average time spent in all activity types and the percentage of adults meeting the current physical activity recommendations. These short-term increases were more marked among adults aged 35 to 64.
The common perception that overall physical activity levels are declining may be over-simplistic as despite the decreases in occupational physical activity, there is a clear upward trend in sports participation. Changes in the measuring methodology over time preclude the presentation of a clear picture of the total temporal trends in physical activity in England.
Increased awareness of the importance of vitamin D to health has led to concerns about the prevalence of hypovitaminosis D in many parts of the world.
We aimed to determine the prevalence of hypovitaminosis D in the white British population and to evaluate the influence of key dietary and lifestyle risk factors.
We measured 25-hydroxyvitamin D [25(OH)D] in 7437 whites from the 1958 British birth cohort when they were 45 y old.
The prevalence of hypovitaminosis D was highest during the winter and spring, when 25(OH)D concentrations <25, <40, and <75 nmol/L were found in 15.5%, 46.6%, and 87.1% of participants, respectively; the proportions were 3.2%, 15.4%, and 60.9%, respectively, during the summer and fall. Men had higher 25(OH)D concentrations, on average, than did women during the summer and fall but not during the winter and spring (P = 0.006, likelihood ratio test for interaction). 25(OH)D concentrations were significantly higher in participants who used vitamin D supplements or oily fish than in those who did not (P < 0.0001 for both) but were not significantly higher in participants who consumed vitamin D-fortified margarine than in those who did not (P = 0.10). 25(OH)D concentrations <40 nmol/L were twice as likely in the obese as in the nonobese and in Scottish participants as in those from other parts of Great Britain (ie, England and Wales) (P < 0.0001 for both).
Prevalence of hypovitaminosis D in the general population was alarmingly high during the winter and spring, which warrants action at a population level rather than at a risk group level.
UK Townsend deprivation scores from 2011 census.
- Yousaf S.
- Bonsall A.
The Ethics and governance Council
- Uk Biobank
UK Biobank. The Ethics and governance Council. 2019. https://www.
ukbiobank.ac.uk/the-ethics-and-governance-council/.
Why the IOM recommendations for vitamin D are deficient
- Heaney
UK Biobank: protocol for a large-scale prospective epidemilogical resource - protocol No: UKBB-PROT-09-06.
- UK Biobank
LIAISON -25 OH vitamin D TOTAL assay
- Diasorin
DiaSorin. LIAISON -25 OH vitamin D TOTAL assay. 2019. https://www.
diasorin.com/sites/default/files/allegati_prodotti/ese_brochure_25_oh_vit._d_
total_low.pdf.