Abstract
Summary
We assessed vitamin D status and its correlates in the population-based Canadian Multicentre Osteoporosis Study (CaMos). Results showed that serum 25-hydroxyvitamin D levels <75 nmol/L were common. Given Canada’s high latitude, attention should be given to strategies for enhancing vitamin D status in the population.
Introduction
Inadequate vitamin D has been implicated as a risk factor for several clinical disorders. We assessed, in a Canadian cohort, vitamin D status and its correlates, based on serum 25-hydroxyvitamin D [25(OH)D], the best functional indicator of vitamin D status.
Methods
We studied 577 men and 1,335 women 35+ years from seven cities across Canada in the randomly selected, population-based Canadian Multicentre Osteoporosis Study (CaMos). Participants completed a comprehensive questionnaire. Serum 25(OH)D was measured by immunoassay. Multivariate linear regression modeling assessed the association between 25(OH)D and determinants of vitamin D status.
Results
Participants (2.3%) were deficient in 25(OH)D (<27.5 nmol/L); a further 18.1% exhibited 25(OH)D insufficiency (27.5–50 nmol/L). Levels <75 nmol/L were evident in 57.5% of men and 60.7% of women and rose to 73.5% in spring (men) and 77.5% in winter (women); 25(OH)D <50 nmol/L was ≤10% year round for those supplementing with ≥400 IU vitamin D/day but was 43.9% among those not supplementing in winter and spring. The strongest predictors of reduced 25(OH)D for both men and women were winter and spring season, BMI ≥30, non-white ethnicity, and lower vitamin D supplementation and its modification by fall and winter.
Conclusions
In this national Canadian cohort, vitamin D levels <75 nmol/L were common, particularly among non-white and obese individuals, and in winter and spring. Vitamin D intake through diet and supplementation and maintenance of normal weight are key modifiable factors for enhancing vitamin D status and thus potentially influencing susceptibility to common chronic diseases.
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Reference
Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281
Standing committee on the Scientific Evaluation of Dietary Intakes FaNBIoM (1997) Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. National Academy Press, Washington, DC, pp 250–287
Balsan S, Garabedian M (1991) Rickets, osteomalacia, and osteopetrosis. Curr Opin Rheumatol 3:496–502
Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B et al (2009) Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. J Bone Miner Res 24:935–942
Krause R, Buhring M, Hopfenmuller W et al (1998) Ultraviolet B and blood pressure. Lancet 352:709–710
Mathieu C, Gysemans C, Giulietti A et al (2005) Vitamin D and diabetes. Diabetologia 48:1247–1257
Gorham ED, Garland CF, Garland FC et al (2007) Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med 32:210–216
Garland CF, Mohr SB, Gorham ED et al (2006) Role of ultraviolet B irradiance and vitamin D in prevention of ovarian cancer. Am J Prev Med 31:512–514
Holick MF (2006) Calcium plus vitamin D and the risk of colorectal cancer. N Engl J Med 354:2287–2288
Munger KL, Levin LI, Hollis BW et al (2006) Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. Jama 296:2832–2838
Rucker D, Allan JA, Fick GH et al (2002) Vitamin D insufficiency in a population of healthy western Canadians. CMAJ 166:1517–1524
Langlois K, Greene-Finestone L, Little J et al (2010) Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Statistics Canada, Ottawa
Gozdzik A, Barta JL, Wu H et al (2008) Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation. BMC Public Health 8:336
Weiler HA, Leslie WD, Bernstein CN (2008) Parathyroid hormone is predictive of low bone mass in Canadian Aboriginal and White women. Bone 42:498–504
Vieth R, Cole DE, Hawker GA et al (2001) Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr 55:1091–1097
Liu BA, Gordon M, Labranche JM et al (1997) Seasonal prevalence of vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc 45:598–603
Kmetic A, Joseph L, Berger C et al (2002) Multiple imputation to account for missing data in a survey: estimating the prevalence of osteoporosis. Epidemiology 13:437–444
Kreiger N, Tenenhouse A, Joseph L et al (1999) The Canadian Multicentre Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387
Carter GD, Carter R, Jones J et al (2004) How accurate are assays for 25-hydroxyvitamin D? Data from the international vitamin D external quality assessment scheme. Clin Chem 50:2195–2197
Phinney KW (2008) Development of a standard reference material for vitamin D in serum. Am J Clin Nutr 88:511S–512S
Wallace AM, Gibson S, de la Hunty A et al (2010) Measurement of 25-hydroxyvitamin D in the clinical laboratory: current procedures, performance characteristics and limitations. Steroids 75:477–488
Looker AC, Lacher DA, Pfeiffer CM et al (2009) Data advisory with regard to NHANES serum 25-hydroxyvitamin D data. Am J Clin Nutr 90:695
Lips P, Bouillon R, van Schoor NM et al (2009) Reducing fracture risk with calcium and vitamin D. Clin Endocrinol (Oxf), in press PMID19744099
Malabanan A, Veronikis IE, Holick MF (1998) Redefining vitamin D insufficiency. Lancet 351:805–806
Pearce SH, Cheetham TD (2010) Diagnosis and management of vitamin D deficiency. Bmj 340:b5664
Bischoff-Ferrari HA, Giovannucci E, Willett WC et al (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28
Dawson-Hughes B, Heaney RP, Holick MF et al (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716
Vatanparast H, Calvo MS, Green TJ et al (2010) Despite mandatory fortification of staple foods, vitamin D intakes of Canadian children and adults are inadequate. J Steroid Biochem Mol Biol 121(1–2):301–303
Canada H (2009) Drug product database online query. Health Canada, Ottawa
Poliquin S, Joseph L, Gray-Donald K (2009) Calcium and vitamin D intakes in an adult Canadian population. Can J Diet Pract Res 70:21–27
Newhook LA, Sloka S, Grant M et al (2009) Vitamin D insufficiency common in newborns, children and pregnant women living in Newfoundland and Labrador, Canada. Matern Child Nutr 5:186–191
Mithal A, Wahl DA, Bonjour JP et al (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20:1807–1820
Jones G, Horst R, Carter G et al (2007) Contemporary diagnosis and treatment of vitamin D-related disorders. J Bone Miner Res 22(Suppl 2):V11–V15
Holick MF, Matsuoka LY, Wortsman J (1989) Age, vitamin D, and solar ultraviolet. Lancet 2:1104–1105
Need AG, Morris HA, Horowitz M et al (1993) Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr 58:882–885
Looker AC, Dawson-Hughes B, Calvo MS et al (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777
Bolland MJ, Grey AB, Ames RW et al (2007) The effects of seasonal variation of 25-hydroxyvitamin D and fat mass on a diagnosis of vitamin D sufficiency. Am J Clin Nutr 86:959–964
Weiler HA, Leslie WD, Krahn J et al (2007) Canadian Aboriginal women have a higher prevalence of vitamin D deficiency than non-Aboriginal women despite similar dietary vitamin D intakes. J Nutr 137:461–465
Lebrun JB, Moffatt ME, Mundy RJ et al (1993) Vitamin D deficiency in a Manitoba community. Can J Public Health 84:394–396
Ward LM, Gaboury I, Ladhani M et al (2007) Vitamin D-deficiency rickets among children in Canada. CMAJ 177:161–166
Canadian Cancer Society (2009) Canadian Cancer Society announces Vitamin D recommendation. Canadian Cancer Society, Toronto
Hopman WM, Leroux C, Berger C et al (2007) Changes in body mass index in Canadians over a five-year period: results of a prospective, population-based study. BMC Public Health 7:150
Shields M, Tremblay MS, Laviolette M et al (2010) Fitness of Canadian adults: results from the 2007-2009 Canadian Health Measures Survey. Health Rep 21:21–35
Tremblay MS, Willms JD (2000) Secular trends in the body mass index of Canadian children. CMAJ 163:1429–1433
Tremblay MS, Shields M, Laviolette M et al (2010) Fitness of Canadian children and youth: results from the 2007-2009 Canadian Health Measures Survey. Health Rep 21:7–20
Wortsman J, Matsuoka LY, Chen TC et al (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690–693
Mark S, Gray-Donald K, Delvin EE et al (2008) Low vitamin D status in a representative sample of youth from Quebec, Canada. Clin Chem 54:1283–1289
Rockell JE, Green TJ, Skeaff CM et al (2005) Season and ethnicity are determinants of serum 25-hydroxyvitamin D concentrations in New Zealand children aged 5-14 y. J Nutr 135:2602–2608
Chumlea WC, Guo SS, Kuczmarski RJ et al (2002) Body composition estimates from NHANES III bioelectrical impedance data. Int J Obes Relat Metab Disord 26:1596–1609
Acknowledgements
The authors would like to thank all the participants in the Canadian Multicentre Osteoporosis Study.
Funding
CaMos was funded by the Canadian Institutes of Health Research (CIHR), Merck Frosst Canada Ltd., Eli Lilly Canada Inc., Novartis Pharmaceuticals Inc., The Alliance for Better Bone Health: Sanofi-Aventis and Procter and Gamble Pharmaceuticals Canada Inc., Amgen, The Dairy Farmers of Canada, The Arthritis Society.
CaMos Research Group
David Goltzman (co-principal investigator, McGill University, Montreal), Nancy Kreiger (co-principal investigator, University of Toronto, Toronto), Alan Tenenhouse (principal investigator emeritus, Toronto),
CaMos Coordinating Centre, McGill University, Montreal, Quebec: Suzette Poliquin (national coordinator), Suzanne Godmaire (research assistant), Claudie Berger (statistician), Wei Zhou (statistician).
Memorial University, St. John’s Newfoundland: Carol Joyce (director), Christopher Kovacs (co-director), Emma Sheppard (coordinator).
Dalhousie University, Halifax, Nova Scotia: Susan Kirkland, Stephanie Kaiser (co-directors), Barbara Stanfield (coordinator).
Laval University, Quebec City, Quebec: Jacques P. Brown (director), Louis Bessette
(co-director), Marc Gendreau (coordinator).
Queen’s University, Kingston, Ontario: Tassos Anastassiades (director), Tanveer Towheed (co-director), Barbara Matthews (coordinator).
University of Toronto, Toronto, Ontario: Bob Josse (director), Sophie Jamal (co-director), Tim Murray (past director), Barbara Gardner-Bray (coordinator)
McMaster University, Hamilton, Ontario: Jonathan D. Adachi (director), Alexandra Papaioannou (co-director), Laura Pickard (coordinator).
University of Saskatchewan, Saskatoon, Saskatchewan: Wojciech P. Olszynski (director),
K. Shawn Davison (co-director), Jola Thingvold (coordinator).
University of Calgary, Calgary, Alberta: David A. Hanley (director), Jane Allan (coordinator).
University of British Columbia, Vancouver, British Columbia: Jerilynn C. Prior (director), Millan Patel (co-director), Brian Lentle (radiologist),Yvette Vigna (coordinator).
Conflicts of interest
D. Goltzman has received honoraria from and served on the advisory boards of Amgen, Eli Lilly, Proctor & Gamble, Merck Frosst, Novartis and Servier. D.A. Hanley has received honoraria from Amgen, Proctor & Gamble, sanofi-aventis, Merck Frosst, and Servier. L Greene-Finestone, C Berger, M de Groh, N Hidiroglou, K Sarafin, S Poliquin, J Krieger, and JB Richards have no conflicts of interest.
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Greene-Finestone, L.S., Berger, C., de Groh, M. et al. 25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates. Osteoporos Int 22, 1389–1399 (2011). https://doi.org/10.1007/s00198-010-1362-7
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DOI: https://doi.org/10.1007/s00198-010-1362-7