Advertisement

Osteoporosis International

, Volume 24, Issue 2, pp 477–488 | Cite as

Vitamin D deficiency in UK South Asian Women of childbearing age: a comparative longitudinal investigation with UK Caucasian women

  • A. L. DarlingEmail author
  • K. H. Hart
  • H. M. Macdonald
  • K. Horton
  • A. R. Kang’ombe
  • J. L. Berry
  • S. A. Lanham-New
Original Article

Abstract

Summary

This is the first 1-year longitudinal study which assesses vitamin D deficiency in young UK-dwelling South Asian women. The findings are that vitamin D deficiency is extremely common in this group of women and that it persists all year around, representing a significant public health concern.

Introduction

There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D.

Methods

This is a 1-year prospective cohort study assessing South Asian (n = 35) and Caucasian (n = 105) premenopausal women living in Surrey, UK (51° N), aged 20–55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry.

Results

Serum 25(OH)D <25 nmol/L was highly prevalent in South Asians in the winter (81 %) and autumn (79.2 %). Deficient status (below 50 nmol/L) was common in Caucasian women. Multi-level modelling suggested that, in comparison to sun exposure (1.59, 95 %CI = 0.83–2.35), dietary intake of vitamin D had no impact on 25(OH)D levels (−0.08, 95 %CI = −1.39 to 1.23).

Conclusions

Year-round vitamin D deficiency was extremely common in South Asian women. These findings pose great health threats regarding the adverse effects of vitamin D deficiency in pregnancy and warrant urgent vitamin D public health policy and action.

Keywords

Longitudinal cohort study Premenopausal women Seasonal 25-hydroxyvitamin D South Asian ethnicity UVB exposure Vitamin D deficiency 

Notes

Acknowledgements

This study was funded by the Foods Standards Agency (N05064). The views expressed are those of the authors and do not necessarily reflect government policy or advice. The authors thank the following individuals for their help with subject recruitment, data collection and analysis: Mrs. S. Starkey, Dr. J. Catterick, Dr. L. Brough, Ms. P. Lee, Ms. A. Bateman and Dr. W.T.K. Lee. The authors would like to acknowledge fully their great appreciation of the following individuals who helped with subject recruitment: Mrs. Freda Smithers, Mrs. Shahnaz Bano, Mrs. Rafeea Mahoon, Mrs. Razia Killedar, Mrs. Roxanna Hanjra, Mrs. Rohini Mahendran and Ms. Judy Dudman.

Dedication

This paper is dedicated to Mr. John Pheasant, Practice Manager at Thornton Heath Medical Centre, London, who helped with the study recruitment and who sadly died in 2008.

Conflicts of interest

ALD, KHH, HMM, ARK, JLB, KH have no disclosures. SLN discloses that she is a research director of D3-TEX Ltd.

References

  1. 1.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  2. 2.
    Bodnar LM, Catov JM, Zmuda JM, Cooper ME, Parrott MS, Roberts JM, Marazita ML, Simhan HN (2010) Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr 140:999–1006PubMedCrossRefGoogle Scholar
  3. 3.
    Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF (2009) Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab 94:940–945PubMedCrossRefGoogle Scholar
  4. 4.
    Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM (2007) Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 92:3517–3522PubMedCrossRefGoogle Scholar
  5. 5.
    Halhali A, Tovar AR, Torres N, Bourges H, Garabedian M, Larrea F (2000) Preeclampsia is associated with low circulating levels of insulin-like growth factor I and 1,25-dihydroxyvitamin D in maternal and umbilical cord compartments. J Clin Endocrinol Metab 85:1828–1833PubMedCrossRefGoogle Scholar
  6. 6.
    Camargo CA Jr, Ingham T, Wickens K, Thadhani R, Silvers KM, Epton MJ, Town GI, Pattemore PK, Espinola JA, Crane J (2010) Cord-blood 25-hydroxyvitamin D levels and risk of respiratory infection, wheezing, and asthma. Pediatrics 127:e180–e187PubMedCrossRefGoogle Scholar
  7. 7.
    Belderbos ME, Houben ML, Wilbrink B, Lentjes E, Bloemen EM, Kimpen JL, Rovers M, Bont L (2011) Cord blood vitamin d deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics 127:e1513–e1520PubMedCrossRefGoogle Scholar
  8. 8.
    Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA (2008) Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One 3:e3753PubMedCrossRefGoogle Scholar
  9. 9.
    Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C (2006) Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 367:36–43PubMedCrossRefGoogle Scholar
  10. 10.
    Mahon P, Harvey N, Crozier S, Inskip H, Robinson S, Arden N, Swaminathan R, Cooper C, Godfrey K (2010) Low maternal vitamin D status and fetal bone development: cohort study. J Bone Miner Res 25:14–19PubMedCrossRefGoogle Scholar
  11. 11.
    Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, Karat SC, Fall CH (2011) Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study. Am J Clin Nutr 93:628–635PubMedCrossRefGoogle Scholar
  12. 12.
    Chi A, Wildfire J, McLoughlin R, Wood RA, Bloomberg GR, Kattan M, Gergen P, Gold DR, Witter F, Chen T, Holick M, Visness C, Gern J, O’Connor GT (2011) Umbilical cord plasma 25-hydroxyvitamin D concentration and immune function at birth: the Urban Environment and Childhood Asthma Study. Clin Exp Allergy 41:842–850PubMedCrossRefGoogle Scholar
  13. 13.
    Camadoo L, Tibbott R, Isaza F (2007) Maternal vitamin D deficiency associated with neonatal hypocalcaemic convulsions. Nutr J 6:23PubMedCrossRefGoogle Scholar
  14. 14.
    Salama MM, El-Sakka AS (2010) Hypocalcemic seizures in breastfed infants with rickets secondary to severe maternal vitamin D deficiency. Pak J Biol Sci 13:437–442PubMedCrossRefGoogle Scholar
  15. 15.
    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 85:860–868PubMedGoogle Scholar
  16. 16.
    Lowe NM, Mitra SR, Foster PC, Bhojani I, McCann JF (2010) Vitamin D status and markers of bone turnover in Caucasian and South Asian postmenopausal women living in the UK. Br J Nutr 103:1706–1710PubMedCrossRefGoogle Scholar
  17. 17.
    DOH (1991) Dietary reference values for food energy and nutrients for the United Kingdom. Report on Health and Social Subjects No. 41. HMSO, LondonGoogle Scholar
  18. 18.
    Nellen JF, Smulders YM, Jos Frissen PH, Slaats EH, Silberbusch J (1996) Hypovitaminosis D in immigrant women: slow to be diagnosed. BMJ 312:570–572PubMedCrossRefGoogle Scholar
  19. 19.
    Sievenpiper JL, McIntyre EA, Verrill M, Quinton R, Pearce SH (2008) Unrecognised severe vitamin D deficiency. BMJ 336:1371–1374PubMedCrossRefGoogle Scholar
  20. 20.
    Macdonald HM, Mavroeidi A, Fraser WD, Darling AL, Black AJ, Aucott L, O’Neill F, Hart K, Berry JL, Lanham-New SA, Reid DM (2010) 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 22:2461–2472PubMedCrossRefGoogle Scholar
  21. 21.
  22. 22.
    ONS (2004) Indices of deprivation 2004 for Super Output Areas in England. ODPMGoogle Scholar
  23. 23.
    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 179:119–129PubMedCrossRefGoogle Scholar
  24. 24.
    SPSS 16.0. Statistical packages for the Social Sciences. Chicago, IL, USAGoogle Scholar
  25. 25.
    Rasbash J, Charlton C, Browne WJ, Healy M, Cameron B (2009) MLwiN version 2.1. Centre for Multilevel Modelling, University of BristolGoogle Scholar
  26. 26.
    IOM (2011) Dietary reference intakes for calcium and vitamin D. National Academies Press, Washington, DCGoogle Scholar
  27. 27.
    Roy DK, Berry JL, Pye SR, Adams JE, Swarbrick CM, King Y, Silman AJ, O'neill TW (2007) Vitamin D status and bone mass in UK South Asian Women. Bone 40:200–4Google Scholar
  28. 28.
    Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O’Neill T (2005) An excess of widespread pain among South Asians: are low levels of vitamin D implicated? Ann Rheum Dis 64:1217–1219PubMedCrossRefGoogle Scholar
  29. 29.
    Brooke-Wavell K, Khan AS, Taylor R, Masud T (2008) Lower calcaneal bone mineral density and broadband ultrasonic attenuation, but not speed of sound, in South Asian than white European women. Ann Hum Biol 35:386–393PubMedCrossRefGoogle Scholar
  30. 30.
    Hill TR, McCarthy D, Jakobsen J, Lamberg-Allardt C, Kiely M, Cashman KD (2007) Seasonal changes in vitamin D status and bone turnover in healthy Irish postmenopausal women. Int J Vitam Nutr Res 77:320–325PubMedCrossRefGoogle Scholar
  31. 31.
    Lappe JM, Davies KM, Travers-Gustafson D, Heaney RP (2006) Vitamin D status in a rural postmenopausal female population. J Am Coll Nutr 25:395–402PubMedGoogle Scholar
  32. 32.
    Henriksen C, Brunvand L, Stoltenberg C, Trygg K, Haug E, Pedersen JI (1995) Diet and vitamin D status among pregnant Pakistani women in Oslo. Eur J Clin Nutr 49:211–218PubMedGoogle Scholar
  33. 33.
    von Hurst PR, Stonehouse W, Coad J (2009) Vitamin D status and attitudes towards sun exposure in South Asian women living in Auckland, New Zealand. Public Health Nutr 13:531–536CrossRefGoogle Scholar
  34. 34.
    Guzel R, Kozanoglu E, Guler-Uysal F, Soyupak S, Sarpel T (2001) Vitamin D status and bone mineral density of veiled and unveiled Turkish women. J Womens Health Gend Based Med 10:765–770PubMedCrossRefGoogle Scholar
  35. 35.
    Matsuoka LY, Wortsman J, Dannenberg MJ, Hollis BW, Lu Z, Holick MF (1992) Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3. J Clin Endocrinol Metab 75:1099–1103PubMedCrossRefGoogle Scholar
  36. 36.
    Brustad M, Alsaker E, Engelsen O, Aksnes L, Lund E (2004) Vitamin D status of middle-aged women at 65–71 degrees N in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr 7:327–335PubMedGoogle Scholar
  37. 37.
    Dharmarajan TS, Akula M, Kuppachi S, Norkus EP (2005) Vitamin D deficiency in community older adults with falls of gait imbalance: an under-recognized problem in the inner city. J Nutr Elder 25:7–19PubMedCrossRefGoogle Scholar
  38. 38.
    Alemzadeh R, Kichler J, Babar G, Calhoun M (2008) Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism 57:183–191PubMedCrossRefGoogle Scholar
  39. 39.
    Saadi HF, Nagelkerke N, Benedict S, Qazaq HS, Zilahi E, Mohamadiyeh MK, Al-Suhaili AI (2006) Predictors and relationships of serum 25 hydroxyvitamin D concentration with bone turnover markers, bone mineral density, and vitamin D receptor genotype in Emirati women. Bone 39:1136–1143PubMedCrossRefGoogle Scholar
  40. 40.
    Hirani V, Mosdol A, Mishra G (2009) Predictors of 25-hydroxyvitamin D status among adults in two British national surveys. Br J Nutr 101:760–764PubMedCrossRefGoogle Scholar
  41. 41.
    Burgaz A, Akesson A, Oster A, Michaelsson K, Wolk A (2007) Associations of diet, supplement use, and ultraviolet B radiation exposure with vitamin D status in Swedish women during winter. Am J Clin Nutr 86:1399–1404PubMedGoogle Scholar
  42. 42.
    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 42:996–1003PubMedCrossRefGoogle Scholar
  43. 43.
    Reusch J, Ackermann H, Badenhoop K (2009) Cyclic changes of vitamin D and PTH are primarily regulated by solar radiation: 5-year analysis of a German (50 degrees N) population. Horm Metab Res 41:402–407PubMedCrossRefGoogle Scholar
  44. 44.
    Kimlin MG (2008) Geographic location and vitamin D synthesis. Mol Aspects Med 29:453–461PubMedCrossRefGoogle Scholar
  45. 45.
    Eyles D, Burne T, McGrath J (2011) Vitamin D in fetal brain development. Semin Cell Dev Biol 22:629–636PubMedCrossRefGoogle Scholar
  46. 46.
    Thandrayen K, Pettifor JM (2010) Maternal vitamin D status: implications for the development of infantile nutritional rickets. Endocrinol Metab Clin North Am 39:303–320 (table of contents)PubMedCrossRefGoogle Scholar
  47. 47.
    Lo C, Paris P, Holick M (1986) Indian and Pakistani immigrants have the same capacity as Caucasians to produce vitamin D in response to ultraviolet irradiation. Am J Clin Nutr 44:683–685PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • A. L. Darling
    • 1
    Email author
  • K. H. Hart
    • 1
  • H. M. Macdonald
    • 2
  • K. Horton
    • 3
  • A. R. Kang’ombe
    • 4
  • J. L. Berry
    • 5
  • S. A. Lanham-New
    • 1
  1. 1.Department of Nutrition and Metabolism, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
  2. 2.Musculoskeletal Research, Health Sciences BuildingUniversity of AberdeenForesterhillUK
  3. 3.School of Health and Social Care, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
  4. 4.Department of Health Sciences, York Trials UnitUniversity of YorkHeslingtonUK
  5. 5.Vitamin D Research Group, Manchester Royal InfirmaryManchesterUK

Personalised recommendations