Osteoporosis International

, Volume 22, Issue 9, pp 2461–2472 | Cite as

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?

  • H. M. Macdonald
  • A. Mavroeidi
  • W. D. Fraser
  • A. L. Darling
  • A. J. Black
  • L. Aucott
  • F. O’Neill
  • K. Hart
  • J. L. Berry
  • S. A. Lanham-New
  • D. M. Reid
Original Article

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.

Keywords

Dietary vitamin D Longitudinal study Postmenopausal women Regional vitamin D status Seasonal 25-hydroxyvitamin D Sunlight exposure 

Supplementary material

198_2010_1467_MOESM1_ESM.doc (26 kb)
ESM 1(DOC 26 kb)

References

  1. 1.
    Department_of_Health (1991) Dietary reference values for food energy and nutrients for the United Kingdom. HMSO, LondonGoogle Scholar
  2. 2.
    Department_of_Health (1998) Nutrition and bone health: with particular reference to calcium and vitamin D. HMSO, LondonGoogle Scholar
  3. 3.
    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):650–656CrossRefGoogle Scholar
  4. 4.
    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):211–217PubMedCrossRefGoogle Scholar
  5. 5.
    Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A (2006) Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 296(23):2832–2838PubMedCrossRefGoogle Scholar
  6. 6.
    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):750–756PubMedCrossRefGoogle Scholar
  7. 7.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16(7):713–716PubMedCrossRefGoogle Scholar
  8. 8.
    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):536–538PubMedCrossRefGoogle Scholar
  9. 9.
    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):996–1003PubMedCrossRefGoogle Scholar
  10. 10.
    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):2195–2197PubMedCrossRefGoogle Scholar
  11. 11.
    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):860–868PubMedGoogle Scholar
  12. 12.
    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–S151PubMedCrossRefGoogle Scholar
  13. 13.
    McLoone P (1994) Carstairs scores for Scottish postcode sectors from the 1991 census. University of Glasgow, GlasgowGoogle Scholar
  14. 14.
    Diffey BL (1999) Human exposure to ultraviolet radiation. In: Hawk J (ed) Photodermatology. Arnold, London, pp 5–24Google Scholar
  15. 15.
    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):175–179PubMedCrossRefGoogle Scholar
  16. 16.
    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–1688SPubMedGoogle Scholar
  17. 17.
    Holick MF (1995) Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 61:638S–645SPubMedGoogle Scholar
  18. 18.
    Dowdy JC, Sayre RM, Holick MF (2010) Holick’s rule and vitamin D from sunlight. J Steroid Biochem Mol Biol 121(1–2):328–330PubMedCrossRefGoogle Scholar
  19. 19.
    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):459–461PubMedCrossRefGoogle Scholar
  20. 20.
    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):119–129PubMedCrossRefGoogle Scholar
  21. 21.
    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):3152–3157PubMedCrossRefGoogle Scholar
  22. 22.
    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, LondonGoogle Scholar
  23. 23.
    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):5766–5772PubMedCrossRefGoogle Scholar
  24. 24.
    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):752–758PubMedCrossRefGoogle Scholar
  25. 25.
    Tjellesen L, Christiansen C (1983) Vitamin D metabolites in normal subjects during one year. A longitudinal study. Scand J Clin Lab Invest 43(1):85–89PubMedGoogle Scholar
  26. 26.
    Holick MF (1994) McCollum award lecture, 1994: vitamin D—new horizons for the 21st century. Am J Clin Nutr 60:619–630PubMedGoogle Scholar
  27. 27.
    Webb AR, Engelsen O (2006) Calculated ultraviolet exposure levels for a healthy vitamin D status. Photochem Photobiol 82(6):1697–1703PubMedGoogle Scholar
  28. 28.
    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.e9CrossRefGoogle Scholar
  29. 29.
    Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69(5):842–856PubMedGoogle Scholar
  30. 30.
    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):17–27CrossRefGoogle Scholar
  31. 31.
    Cannell JJ, Hollis BW, Zasloff M, Heaney RP (2008) Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother 9(1):107–118PubMedCrossRefGoogle Scholar
  32. 32.
    Chen TC (ed) (1998) Photobiology of vitamin D. Human, TotowaGoogle Scholar
  33. 33.
    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 2:303–305PubMedCrossRefGoogle Scholar
  34. 34.
    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):1777–1783PubMedCrossRefGoogle Scholar
  35. 35.
    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):1052–1058PubMedCrossRefGoogle Scholar
  36. 36.
    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. Google Scholar
  37. 37.
    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):649–650PubMedGoogle Scholar
  38. 38.
    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):551–561PubMedCrossRefGoogle Scholar
  39. 39.
    Hathcock JN, Shao A, Vieth R, Heaney R (2007) Risk assessment for vitamin D. Am J Clin Nutr 85(1):6–18PubMedGoogle Scholar
  40. 40.
    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):23CrossRefGoogle Scholar
  41. 41.
    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):1815–1822PubMedCrossRefGoogle Scholar
  42. 42.
    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):204–210PubMedGoogle Scholar
  43. 43.
    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 163:435–436CrossRefGoogle Scholar
  44. 44.
    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):439–448PubMedGoogle Scholar
  45. 45.
    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):200–204PubMedCrossRefGoogle Scholar
  46. 46.
    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):117–121PubMedCrossRefGoogle Scholar
  47. 47.
    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):103–109PubMedCrossRefGoogle Scholar
  48. 48.
    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 102:382–386PubMedCrossRefGoogle Scholar
  49. 49.
    SACN (ed) (2007) Update on vitamin D: position statement by the Scientific Advisory Committee on Nutrition. TSO, LondonGoogle Scholar
  50. 50.
    Diffey BL (2010) Modelling the seasonal variation of vitamin D due to sun exposure. Br J Dermatol 162(6):1342–1348PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • H. M. Macdonald
    • 1
    • 5
  • A. Mavroeidi
    • 1
  • W. D. Fraser
    • 2
  • A. L. Darling
    • 3
  • A. J. Black
    • 1
  • L. Aucott
    • 1
  • F. O’Neill
    • 1
  • K. Hart
    • 3
  • J. L. Berry
    • 4
  • S. A. Lanham-New
    • 3
  • D. M. Reid
    • 1
  1. 1.University of AberdeenAberdeenUK
  2. 2.Department of Musculoskeletal BiologyUniversity of LiverpoolLiverpoolUK
  3. 3.Nutritional Sciences Division, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
  4. 4.Vitamin D Research Group, Department of MedicineManchester Royal InfirmaryManchesterUK
  5. 5.Musculoskeletal Research, Health Sciences BuildingUniversity of AberdeenAberdeenUK

Personalised recommendations