Abstract
Summary
We assessed sunlight and dietary contributions to vitamin D status in British postmenopausal women. Our true longitudinal 25-hydroxyvitamin D (25(OH)D) measurements varied seasonally, being lower in the north compared to the south and lower in Asian women. Sunlight exposure in summer and spring provided 80% total annual intake of vitamin D.
Introduction
Vitamin D deficiency is highlighted as a potential problem for countries at high latitude, but there are few true longitudinal, seasonal data to allow regional comparisons. We aimed to directly compare seasonal variation in vitamin D status (25(OH)D) in postmenopausal women at two northerly latitudes and to assess the relative contributions of sunlight exposure and diet.
Methods
Vitamin D status was assessed in 518 postmenopausal women (age 55–70 years) in a two-centre cohort study with serum collected at fixed three-monthly intervals from summer 2006 for immunoassay measurement of 25(OH)D and parathyroid hormone. At 57° N (Aberdeen, Scotland, UK), there were 338 Caucasian women; at 51° N (Surrey, South of England, UK), there were 144 Caucasian women and 35 Asian women. UVB exposure (polysulphone film badges) and dietary vitamin D intakes (food diaries) were also estimated.
Results
Caucasian women had lower 25(OH)D (p < 0.001) at 57° N compared to 51° N. Median (interquartile range) in nanomoles per litre for summer (June–August) at 57° N was 43.0 (20.9) and at 51° N was 62.5 (26.6) and for winter (December–February) at 57° N was 28.3 (18.9) and at 51° N was 39.9 (24.0). For Asian women at 51° N, median 25(OH)D was 24.0 (15.8) nmol/L in summer and 16.9 (15.9) nmol/L in winter. Median dietary vitamin D intakes were 80–100 IU for Caucasians and 50–65 IU for the Asian women. Sunlight was the main contributor to 25(OH)D with spring and summer providing >80% total annual intake.
Conclusions
These longitudinal data show significant regional and ethnic differences in UVB exposure and vitamin D status for postmenopausal women at northerly latitudes. The numbers of women who are vitamin D deficient is a major concern and public health problem.
Similar content being viewed by others
References
Department_of_Health (1991) Dietary reference values for food energy and nutrients for the United Kingdom. HMSO, London
Department_of_Health (1998) Nutrition and bone health: with particular reference to calcium and vitamin D. HMSO, London
Pittas AG, Dawson-Hughes B, Li T, Van Dam RM, Willett WC, Manson JE et al (2006) Vitamin D and calcium intake in relation to type 2 diabetes in women. Diab Care 29(3):650–656
Lind L, Lithell H, Skarfors E, Wide L, Ljunghall S (1988) Reduction of blood pressure by treatment with alphacalcidol. A double-blind, placebo-controlled study in subjects with impaired glucose tolerance. Acta Med Scand 223(3):211–217
Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A (2006) Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 296(23):2832–2838
Slattery ML, Neuhausen SL, Hoffman M, Caan B, Curtin K, Ma KN et al (2004) Dietary calcium, vitamin D, VDR genotypes and colorectal cancer. Int J Cancer 111(5):750–756
Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16(7):713–716
McLaughlin M, Raggatt PR, Fairney A, Brown DJ, Lester E, Wills MR (1974) Seasonal variations in serum 25-hydroxycholecalciferol in healthy people. Lancet 1(7857):536–538
Macdonald HM, Mavroeidi A, Barr RJ, Black AJ, Fraser WD, Reid DM (2008) Vitamin D status in postmenopausal women living at higher latitudes in the UK in relation to bone health, overweight, sunlight exposure and dietary vitamin D. Bone 42(5):996–1003
Carter GD, Carter R, Jones J, Berry J (2004) How accurate are assays for 25-hydroxyvitamin D? Data from the international vitamin D external quality assessment scheme. Clin Chem 50(11):2195–2197
Hypponen E, Power C (2007) Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 85(3):860–868
Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S et al (1997) Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24 hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 26(Suppl 1):S137–S151
McLoone P (1994) Carstairs scores for Scottish postcode sectors from the 1991 census. University of Glasgow, Glasgow
Diffey BL (1999) Human exposure to ultraviolet radiation. In: Hawk J (ed) Photodermatology. Arnold, London, pp 5–24
Challoner AV, Corless D, Davis A, Deane GH, Diffey BL, Gupta SP et al (1976) Personnel monitoring of exposure to ultraviolet radiation. Clin Exp Dermatol 1(2):175–179
Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80(6 Suppl):1678S–1688S
Holick MF (1995) Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 61:638S–645S
Dowdy JC, Sayre RM, Holick MF (2010) Holick’s rule and vitamin D from sunlight. J Steroid Biochem Mol Biol 121(1–2):328–330
Mavroeidi A, O’Neill F, Lee PA, Darling AL, Fraser WD, Berry JL et al (2010) Seasonal 25-hydroxyvitamin D changes in British postmenopausal women at 57 degrees N and 51 degrees N: a longitudinal study. J Steroid Biochem Mol Biol 121(1–2):459–461
Pal BR, Marshall T, James C, Shaw NJ (2003) Distribution analysis of vitamin D highlights differences in population subgroups: preliminary observations from a pilot study in UK adults. J Endocrinol 179(1):119–129
Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE et al (2004) Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 89(7):3152–3157
Henderson L, Irving K, Gregory J, Bates CJ, Prentice A, Perks J et al (eds) (2003) National diet and nutrition survey: adults aged 19 to 64 years. TSO, London
Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the longitudinal aging study Amsterdam. J Clin Endocrinol Metab 88(12):5766–5772
Pasco JA, Henry MJ, Kotowicz MA, Sanders KM, Seeman E, Pasco JR et al (2004) Seasonal periodicity of serum vitamin D and parathyroid hormone, bone resorption, and fractures: the Geelong Osteoporosis Study. J Bone Miner Res 19(5):752–758
Tjellesen L, Christiansen C (1983) Vitamin D metabolites in normal subjects during one year. A longitudinal study. Scand J Clin Lab Invest 43(1):85–89
Holick MF (1994) McCollum award lecture, 1994: vitamin D—new horizons for the 21st century. Am J Clin Nutr 60:619–630
Webb AR, Engelsen O (2006) Calculated ultraviolet exposure levels for a healthy vitamin D status. Photochem Photobiol 82(6):1697–1703
Terushkin V, Bender A, Psaty EL, Engelsen O, Wang SQ, Halpern AC (2010) Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes. J Am Acad Dermatol 62(6):929.e1–929.e9
Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69(5):842–856
Clements MR, Davies M, Hayes ME, Hickey CD, Lumb GA, Mawer EB et al (1992) The role of 1, 25-dihydroxyvitamin D in the mechanism of acquired vitamin D deficiency. Clin Endocrinol (Oxf) 37(1):17–27
Cannell JJ, Hollis BW, Zasloff M, Heaney RP (2008) Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother 9(1):107–118
Chen TC (ed) (1998) Photobiology of vitamin D. Human, Totowa
Lawson DEM, Paul AA, Black AE, Cole TJ, Mandal AR, Davie M (1979) Relative contributions of diet and sunlight to vitamin D state in the elderly. Brit Med J 2:303–305
Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson-Hughes B (1989) Effect of vitamin D intake on seasonal variations in parathyroid hormone secretion in postmenopausal women. N Engl J Med 321(26):1777–1783
Ooms ME, Roos JC, Bezemer PD, van der Vijgh WJ, Bouter LM, Lips P (1995) Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind trial. J Clin Endocrinol Metab 80(4):1052–1058
Heaney R, Vieth R (2009) Optimal health requires 25(OH)D levels >40 ng/ml (100 nmol/L). 14th workshop on vitamin D, Brugge, Belgium.
Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP et al (2007) The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 85(3):649–650
Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ et al (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 169(6):551–561
Hathcock JN, Shao A, Vieth R, Heaney R (2007) Risk assessment for vitamin D. Am J Clin Nutr 85(1):6–18
Reis DA, Silva CC, Pontes AB, Zaupa MC, Gomes VCA, Costa DF et al (2009) Risk factors for atherosclerosis: prevalence of the extreme arterial alcohol consumption and systemic hypertension in the Brazilian Capitals, the period of 2002 the 2005. Atheroscler Suppl 10(3):23
Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D et al (2010) Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 303(18):1815–1822
Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77(1):204–210
Macdonald HM, Mavroeidi A, Reid DM, Fraser WD (2010) Sunlight or diet: what is the answer for providing sufficient vitamin D in the UK? Br J Dermatol 163:435–436
Finch PJ, Ang L, Eastwood JB, Maxwell JD (1992) Clinical and histological spectrum of osteomalacia among Asians in south London. Q J Med 83(302):439–448
Roy DK, Berry JL, Pye SR, Adams JE, Swarbrick CM, King Y et al (2007) Vitamin D status and bone mass in UK South Asian women. Bone 40(1):200–204
Ward KA, Roy DK, Pye SR, O’Neill TW, Berry JL, Swarbrick CM et al (2007) Forearm bone geometry and mineral content in UK women of European and South-Asian origin. Bone 41(1):117–121
Falch JA, Steihaug S (2000) Vitamin D deficiency in Pakistani premenopausal women living in Norway is not associated with evidence of reduced skeletal strength. Scand J Clin Lab Invest 60(2):103–109
Goswami R, Marwaha RK, Gupta N, Tandon N, Sreenivas V, Tomar N et al (2009) Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr 102:382–386
SACN (ed) (2007) Update on vitamin D: position statement by the Scientific Advisory Committee on Nutrition. TSO, London
Diffey BL (2010) Modelling the seasonal variation of vitamin D due to sun exposure. Br J Dermatol 162(6):1342–1348
Acknowledgements
The authors wish to thank John Leiper and Sharon Gordon who helped with the volunteers’ visits; Antonia Hardcastle and Kim Giles for their help with data entry and checking; Catherine Paterson and Katie Macdonald for entering sunlight diaries; Anna Robinson, Liverpool for analysis of 25(OH)D and Fiona Grant who helped with recruitment. The authors are particularly grateful to Brian Diffey for the advice on sunlight exposure estimation (badges and sunlight diaries). Finally, we wish to thank all the women who took part and without whose commitment this study would not have been possible. SL-N is grateful to the Woking Asian Women’s Association (WAWA); the Khidmat Group, Woking; the Islamic Resource Centre (IRC) Kingston; The Guildford Asian Society and the Thornton Heath Asian Society.
Conflicts of interest
WDF has patents pending between IDS and the University of Liverpool. No disclosures for other authors. This work was funded by the UK Food Standards Agency. Any views expressed are the authors’ own.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s00198-011-1548-7
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOC 26 kb)
Rights and permissions
About this article
Cite this article
Macdonald, H.M., Mavroeidi, A., Fraser, W.D. et al. Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: a major cause for concern?. Osteoporos Int 22, 2461–2472 (2011). https://doi.org/10.1007/s00198-010-1467-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-010-1467-z