Cancer Causes & Control

, Volume 21, Issue 4, pp 501–511

Determinants of serum 25 hydroxyvitamin D levels in a nationwide cohort of blacks and non-Hispanic whites

  • Jacqueline Chan
  • Karen Jaceldo-Siegl
  • Gary E. Fraser
Original paper



To develop algorithms predicting serum 25 hydroxyvitamin D [s25(OH)D] for a large epidemiological study whose subjects come from large geographic areas, are racially diverse and have a wide range in age, skin types, and month of blood sample collection. This will allow a regression calibration approach to determine s25(OH)D levels replacing the more costly method of collection and analysis of blood samples.

Study design and setting

Questionnaire data from a subsample of 236 non-Hispanic whites (whites) and 209 blacks from the widely dispersed Adventist Health Study-2 (n = 96,000) were used to develop prediction algorithms for races separately and combined. A single blood sample was collected from each subject, at different times throughout the year.


Models with independent variables age, sex, BMI, skin type, UV season, erythemal zone, total dietary vitamin D intake, and sun exposure factor explained 22 and 31% of the variance of s25(OH)D levels in white and black populations, respectively (42% when combined). UV season and erythemal zone determined from measured UV radiation produced models with higher R2 than season and latitude.


Combining races with a term for race and using variables with measured UV radiation capture the variance in s25(OH)D levels better than analyzing races separately.


Cancer Serum 25-hydroxyvitamin D Predictors Adventist health study-2 Blacks Whites 

Supplementary material


  1. 1.
    Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87:1080–1086Google Scholar
  2. 2.
    Chen TC, Chimeh F, Lu Z et al (2007) Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys 460:213–217CrossRefPubMedGoogle Scholar
  3. 3.
    Holick MF, MacLaughlin JA, Doppelt SH (1981) Regulation of cutaneous previtamin D3 photosynthesis in man: skin pigment is not an essential regulator. Science 211:590–593CrossRefPubMedGoogle Scholar
  4. 4.
    Egan K, Signorello L, Munro H, Hargreaves M, Hollis B, Blot W (2008) Vitamin D insufficiency among African–Americans in the southeastern United States: implications for cancer disparities (United States). Cancer Causes Control 19:527–535CrossRefPubMedGoogle Scholar
  5. 5.
    Giovannucci E, Liu Y, Rimm EB et al (2006) Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst 98:451–459PubMedCrossRefGoogle Scholar
  6. 6.
    Jacobs ET, Alberts DS, Foote JA et al (2008) Vitamin D insufficiency in southern Arizona. Am J Clin Nutr 87:608–613PubMedGoogle Scholar
  7. 7.
    Johnson MA, Davey A, Park S, Hausman DB, Poon LW (2008) Age, race and season predict vitamin d status in African American and white octogenarians and centenarians. J Nutr Health Aging 12:690–695PubMedGoogle Scholar
  8. 8.
    Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR (2002) Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 30:771–777CrossRefPubMedGoogle Scholar
  9. 9.
    Nesby-O’Dell S, Scanlon KS, Cogswell ME et al (2008) Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third national health and nutrition examination survey, 1988–1994. Am J Clin Nutr 76:187–192Google Scholar
  10. 10.
    van der Meer IM, Boeke AJP, Lips P et al (2008) Fatty fish and supplements are the greatest modifiable contributors to the serum 25-hydroxyvitamin D concentration in a multiethnic population. Clin Endocrinol 68:466–472Google Scholar
  11. 11.
    Bolland MJ, Chiu WW, Davidson JS et al (2008) The effects of seasonal variation of 25-hydroxyvitamin D on diagnosis of vitamin D insufficiency. N Z Med J 121:63–74PubMedGoogle Scholar
  12. 12.
    Holick MF (2005) 25-OH-vitamin D assays. J Clin Endocrinol Metab 90:3128–3129CrossRefPubMedGoogle Scholar
  13. 13.
    Jacques PF, Felson DT, Tucker KL et al (1997) Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample. Am J Clin Nutr 66:929–936PubMedGoogle Scholar
  14. 14.
    MacLaughlin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538CrossRefPubMedGoogle Scholar
  15. 15.
    Need AG, Morris HA, Horowitz M, Nordin C (1993) Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr 58:882–885PubMedGoogle Scholar
  16. 16.
    Holick MF (2005) The vitamin D epidemic and its health consequences. J Nutr 135:2739–2748Google Scholar
  17. 17.
    Lucas J, Bolland M, Grey A et al (2005) Determinants of vitamin D status in older women living in a subtropical climate. Osteoporos Int 16:1641–1648CrossRefPubMedGoogle Scholar
  18. 18.
    McKinney K, Breitkopf CR, Berenson AB (2008) Association of race, body fat, and season with vitamin D status among young women: a cross-sectional study. Clin Endocrinol 69:535–541CrossRefGoogle Scholar
  19. 19.
    Rock CL, Thornquist MD, Kristal AR et al (1999) Demographic, dietary and lifestyle factors differentially explain variability in serum carotenoids and fat-soluble vitamins: baseline results from the sentinel site of the Olestra post-marketing surveillance study. J Nutr 129:855–864PubMedGoogle Scholar
  20. 20.
    Clemens TL, Henderson SL, Adams JS, Holick MF (1982) Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 319:74–76CrossRefGoogle Scholar
  21. 21.
    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 8:336CrossRefPubMedGoogle Scholar
  22. 22.
    Holick MF (1981) The cutaneous photosynthesis of previtamin D3: a unique photoendocrine system. J Invest Dermatol 77:51–58CrossRefPubMedGoogle Scholar
  23. 23.
    Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64:1165–1168CrossRefPubMedGoogle Scholar
  24. 24.
    Hill TR, O’Brien MM, Lamberg-Allardt C et al (2006) Vitamin D status of 51–75 year-old Irish women: its determinants and impact on biochemical indices of bone turnover. Public Health Nutr 9:225–233CrossRefPubMedGoogle Scholar
  25. 25.
    Hintzpeter B, Mensink GBM, Thierfelder W, Muller MJ, Scheidt-Nave C (2007) Vitamin D status and health correlates among German adults. Eur J Clin Nutr 62:1079–1089CrossRefPubMedGoogle Scholar
  26. 26.
    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
  27. 27.
    Looker AC (2005) Body fat and vitamin D status in black versus white women. J Clin Endocrinol Metab 90:635–640CrossRefPubMedGoogle Scholar
  28. 28.
    Fu L, Yun F, Oczak M, Wong BY, Vieth R, Cole DE (2009) Common genetic variants of the vitamin D binding protein (DBP) predict differences in response of serum 25-hydroxyvitamin D [25(OH)D] to vitamin D supplementation. Clin Biochem 40:1174–1177CrossRefGoogle Scholar
  29. 29.
    Andersen R, Molgaard C, Skovgaard LT et al (2005) Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Eur J Clin Nutr 59:533–541CrossRefPubMedGoogle Scholar
  30. 30.
    Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sørensen OH (2001) Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Br J Nutr 86:97–103CrossRefGoogle Scholar
  31. 31.
    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
  32. 32.
    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
  33. 33.
    Hirani V, Mosdol A, Mishra G (2009) Predictors of 25-hydroxyvitamin D status among adults in two British national surveys. Br J Nutr 101:760–764CrossRefPubMedGoogle Scholar
  34. 34.
    Lips P, van Ginkel FC, Jongen MJ et al (1987) Determinants of vitamin D status in patients with hip fracture and in elderly control subjects. Am J Clin Nutr 46:1005–1010PubMedGoogle Scholar
  35. 35.
    van Dam RM, Snijder MB, Dekker JM et al (2007) Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn study. Am J Clin Nutr 85:755–761PubMedGoogle Scholar
  36. 36.
    McCarty CA (2008) Sunlight exposure assessment: can we accurately assess vitamin D exposure from sunlight questionnaires? Am J Clin Nutr 87:1097–1101Google Scholar
  37. 37.
    Millen AE, Bodnar LM (2008) Vitamin D assessment in population-based studies: a review of the issues. Am J Clin Nutr 87:1102–1105Google Scholar
  38. 38.
    Hoeppe P, Oppenrieder A, Erianto C et al (2004) Visualization of UV exposure of the human body based on data from a scanning UV-measuring system. Int J Biometeorol 49:18–25CrossRefPubMedGoogle Scholar
  39. 39.
    Webb AR, Weihs P, Blumthaler M (1999) Spectral UV radiance on vertical surfaces: a case study. Photochem Photobiol 69:464–470CrossRefPubMedGoogle Scholar
  40. 40.
    Ozone Processing Team (2006) Monthly average local noon erythemal irradiance, v.8. NASA
  41. 41.
    Butler TL, Fraser GE, Beeson WL et al (2008) Cohort profile: the adventist health study-2 (AHS-2). Int J Epidemiol 37:260–265CrossRefPubMedGoogle Scholar
  42. 42.
    Jaceldo-Siegl K, Knutsen S, Sabate J et al. (2009) Validation of nutrient intake using a food-frequency questionnaire and repeated 24 h recalls in Black and White subjects of the Adventist Health Study-2 (AHS-2). Public Health Nutr (in press)Google Scholar
  43. 43.
    Willett WC, Stampfer MJ (1998) Implications of total energy intake for epidemiologic analyses. In: Willett W (ed) Nutritional epidemiology, 2nd edn. Oxford University Press, New York, pp 273–301Google Scholar
  44. 44.
    Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124:869–871CrossRefPubMedGoogle Scholar
  45. 45.
    Wachtel TL, Berry CC, Wachtel EE, Frank HA (2000) The inter-rater reliability of estimating the size of burns from various burn area chart drawings. Burns 26:156–170CrossRefPubMedGoogle Scholar
  46. 46.
    Diffey BL (1991) Solar ultraviolet radiation effects on biological systems. J Phys Medicine Biology 36:299–328CrossRefGoogle Scholar
  47. 47.
    Webb AR, Engelsen O (2006) Calculated ultraviolet exposure levels for a healthy vitamin D status. Photochem Photobiol 82:1697–1703PubMedGoogle Scholar
  48. 48.
    Fraser DR (1983) The physiological economy of vitamin D. Lancet 1:969–972CrossRefPubMedGoogle Scholar
  49. 49.
    Haddad JG, Matsuoka LY, Hollis BW, Hu YZ, Wortsman J (1993) Human plasma transport of vitamin D after its endogenous synthesis. J Clin Invest 91:2552–2555CrossRefPubMedGoogle Scholar
  50. 50.
    Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690–693PubMedGoogle Scholar
  51. 51.
    Young KA, Engelman CD, Langefeld CD et al (2009) Association of plasma vitamin D levels with adiposity in Hispanic and African Americans. J Clin Endocrinol Metab 94:3306–3313CrossRefPubMedGoogle Scholar
  52. 52.
    Malvy DJM, Guinot C, Preziosi P et al (2000) Relationship between vitamin D status and skin phototype in general adult population. Photochem Photobiol 71:466–469CrossRefPubMedGoogle Scholar
  53. 53.
    Fears TR, Bird CC, Guerry DIV et al (2002) Average midrange ultraviolet radiation flux and time outdoors predict melanoma risk. Cancer Res 62:3992–3996PubMedGoogle Scholar
  54. 54.
    Lee-Taylor J, Madronich S (2007) Climatology of UV-A, UV-B, and erythemal radiation at the earth’s surface, 1979–2000. NCAR Technical Note TN-474-STRGoogle Scholar
  55. 55.
    Al-Delaimy WK, Jansen EHJM, Peeters PHM et al (2006) Reliability of biomarkers of iron status, blood lipids, oxidative stress, vitamin D, C-reactive protein and fructosamine in two Dutch cohorts. Biomarkers V11:370–382CrossRefGoogle Scholar
  56. 56.
    Feskanich D, Ma J, Fuchs CS et al (2004) Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev 13:1502–1508PubMedGoogle Scholar
  57. 57.
    Fraser GE (2003) A search for truth in dietary epidemiology. Am J Clin Nutr 78:521–525Google Scholar
  58. 58.
    Bischoff-Ferrari HA, Dawson-Hughes B (2007) Where do we stand on vitamin D? Bone 41:S13–S19CrossRefPubMedGoogle Scholar
  59. 59.
    Hollis BW (2008) Measuring 25-hydroxyvitamin D in a clinical environment: challenges and needs. Am J Clin Nutr 88:507–510Google Scholar
  60. 60.
    Ovesen L, Brot C, Jakobsen J (2003) Food contents and biological activity of 25-hydroxyvitamin D:A vitamin D metabolite to be reckoned with? Ann Nutr Metab 47:107–113CrossRefPubMedGoogle Scholar
  61. 61.
    Holden JM, Lemar LE, Exler J (2008) Vitamin D in foods: development of the US Department of Agriculture database. Am J Clin Nutr 87:1092–1096Google Scholar
  62. 62.
    Dlugos DJ, Perrotta PL, Horn WG (1995) Effects of the submarine environment on renal-stone risk factors and vitamin D metabolism. Undersea Hyperb Med 22:145–152PubMedGoogle Scholar
  63. 63.
    Holick MF (1989) Vitamin D: biosynthesis, metabolism, and mode of action. In: DeGroot LJ, Cahill GF Jr, Martini L et al (eds) Endocrinology. Grune and Stratton, New York, pp 902–926Google Scholar
  64. 64.
    Kobayashi T, Okano T, Shida S et al (1983) Variation of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 levels in human plasma obtained from 758 Japanese healthy subjects. J Nutr Sci Vitaminol (Tokyo) 29:271–281Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Jacqueline Chan
    • 1
  • Karen Jaceldo-Siegl
    • 1
  • Gary E. Fraser
    • 1
  1. 1.Department of Epidemiology and Biostatistics, School of Public HealthLoma Linda UniversityLoma LindaUSA

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