Skip to main content
SpringerLink
Log in

Prevalence and Determinants of Vitamin D Deficiency Among the Overweight and Obese Singaporeans Seeking Weight Management Including Bariatric Surgery: a Relationship with Bone Health

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

Low vitamin D status is prevalent worldwide and has been linked to a variety of pathologies including obesity in adults. The severity of vitamin D deficiency amongst the overweight and obese Singaporeans is not well documented. The purpose of this prospective observational study was to assess the prevalence and determinants of vitamin D deficiency in a multi-ethnic Asian population referred for weight management, including those seeking bariatric surgery.

Materials and Methods

This was a cross-sectional study conducted among 111 consecutive subjects referred to a single institution weight management service in Singapore. The data collected included their anthropometric data, body mass index (BMI), body fat percentage, waist circumference, 25-hydroxyvitamin D [25(OH)D] and other bone turnover markers.

Results

The average BMI among the 111 subjects was 40.1 ± 8.2 kg/m2 and mean age of 40 ± 10 years. Vitamin D deficiency was found in 75.7% of the population. There was a significant negative association of vitamin D with adiposity markers including BMI (r = − 0.31), body fat percentage (r = − 0.34) and waist circumference (r = − 0.26). Predictors of vitamin D deficiency included age > 50 years, female gender, waist circumference and body fat percentage.

Conclusion

Vitamin D deficiency is prevalent among this target population in Singapore regardless of ethnicity. In particular, the elderly, females, those with larger waist circumference and body fat percentage were significantly associated with lower serum 25(OH)D level. Hence, routine screening for the overweight and obese subjects in multi-ethnic Singapore seeking weight management is indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Prentice A. Vitamin D deficiency: a global perspective. Nutr Rev. 2008;66(10 Suppl 2):S153–64.

    Article  PubMed  Google Scholar 

  2. Larose TL, Chen Y, Camargo Jr CA, et al. Factors associated with vitamin D deficiency in a Norwegian population: the HUNT study. J Epidemiol Community Health. 2014;68(2):165–70.

    Article  PubMed  Google Scholar 

  3. Palacios C, Gil K, Pérez CM, et al. Determinants of vitamin D status among overweight and obese Puerto Rican adults. Ann Nutr Metab. 2012;60(1):35–43.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Clemens TL, Adams JS, Henderson SL, et al. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet. 1982;1(8263):74–6.

    Article  PubMed  CAS  Google Scholar 

  5. Earthman CP, Beckman LM, Masodkar K, et al. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes. 2012;36(3):387–96.

    Article  CAS  Google Scholar 

  6. Vilarrasa N, Maravall J, Estepa A, et al. Low 25-hydroxyvitamin D concentrations in obese women: their clinical significance and relationship with anthropometric and body composition variables. J Endocrinol Investig. 2007;30(8):653–8.

    Article  CAS  Google Scholar 

  7. Bi X, Tey SL, Leong C, et al. Prevalence of vitamin D deficiency in Singapore: its implications to cardiovascular risk factors. PLoS One. 2016;11(1):e0147616.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Costa TL, Paganotto M, Radominski RB, et al. Calcium metabolism, vitamin D and bone mineral density after bariatric surgery. Osteoporos Int. 2015;26(2):757–64.

    Article  PubMed  CAS  Google Scholar 

  9. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.

  10. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. Nutrition. 1989;5(5):303–11.

    PubMed  Google Scholar 

  11. Holick MF, Vitamin D. Status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19(2):73–8.

    Article  PubMed  Google Scholar 

  12. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.

    Article  PubMed  CAS  Google Scholar 

  13. Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B. Regional variation and determinants of vitamin D status in sunshine-abundant Thailand. BMC Public Health. 2011;11:853.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Kim M, Na W, Sohn C. Correlation between vitamin D and cardiovascular disease predictors in overweight and obese Koreans. J Clin Biochem Nutr. 2013;52(2):167–71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S–6S.

    Article  PubMed  CAS  Google Scholar 

  16. Parker J, Hashmi O, Dutton D, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas. 2010;65(3):225–36.

    Article  PubMed  CAS  Google Scholar 

  17. Ke L, Mason RS, Mpofu E, Vingren JL, Li Y, Graubard BI et al. Hypertension and other cardiovascular risk factors are associated with vitamin D deficiency in an urban Chinese population: A short report. J Steroid Biochem Mol Biol. 2017;173:286–291

  18. Lappe JM, Travers-Gustafson D, Davies KM, et al. Calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85(6):1586–91.

    Article  PubMed  CAS  Google Scholar 

  19. Shafinaz IS, Moy FM. Vitamin D level and its association with adiposity among multi-ethnic adults in Kuala Lumpur, Malaysia: a cross sectional study. BMC Public Health. 2016;16:232.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Nurbazlin M, Chee WS, Rokiah P, et al. Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia. Asia Pac J Clin Nutr. 2013;22(3):391–9. PMID: 23945409

    PubMed  CAS  Google Scholar 

  21. Cheng S, Massaro JM, Fox CS, et al. Adiposity, cardiometabolic risk, and vitamin D status: the Framingham heart study. Diabetes. 2010;59(1):242–8.

    Article  PubMed  CAS  Google Scholar 

  22. Matsuoka LY, Wortsman J, Haddad JG, et al. Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol. 1991;127(4):536–8.

    Article  PubMed  CAS  Google Scholar 

  23. Glass D, Lens M, Swaminathan R, et al. Pigmentation and vitamin D metabolism in Caucasians: low vitamin D serum levels in fair skin types in the UK. PLoS One. 2009;4(8):e6477.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Green TJ, Skeaff CM, Rockell JEP, et al. Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr. 2008;62:373–8.

    Article  PubMed  CAS  Google Scholar 

  25. Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet. 1989;2(8671):1104–5.

    Article  PubMed  CAS  Google Scholar 

  26. Kimball S, Fuleihan GE-H, Vieth R. Vitamin D: a growing perspective. Crit Rev Clin Lab Sci. 2008;45:339–414.

    Article  PubMed  CAS  Google Scholar 

  27. Dandona P, Menon RK, Shenoy R, et al. Low 1,25-dihydroxyvitamin D, secondary hyperparathyroidism, and normal osteocalcin in elderly subjects. J Clin Endocrinol Metab. 1986;63(2):459–62.

    Article  PubMed  CAS  Google Scholar 

  28. United States Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans, 6th ed. Washington: US Government Printing Office; 2005.

  29. Whiting SJ, Calvo MS. Correcting poor vitamin D status: do older adults need higher repletion doses of vitamin D3 than younger adults? Mol Nutr Food Res. 2010;54(8):1077–84.

    PubMed  CAS  Google Scholar 

  30. Steingrimsdottir L, Gunnarsson O, Indridason OS, et al. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA. 2005;294(18):2336–41.

    Article  PubMed  CAS  Google Scholar 

  31. Sigurdsson G, Franzson L, Steingrimsdottir L, et al. The association between parathyroid hormone, vitamin D and bone mineral density in 70-year-old Icelandic women. Osteoporos Int. 2000;11:1031–5.

    Article  PubMed  CAS  Google Scholar 

  32. Heaney RP. Is the paradigm shifting? Bone. 2003;33:457–65.

    Article  PubMed  Google Scholar 

  33. Thomas SD, Need AG, Nordin BE. Suppression of C-terminal telopeptide in hypovitaminosis D requires calcium as well as vitamin D. Calcif Tissue Int. 2010;86(5):367–74.

    Article  PubMed  CAS  Google Scholar 

  34. Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.

    Article  PubMed  CAS  Google Scholar 

  35. Sinha N, Shieh A, Stein EM, et al. Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity. 2011;19(12):2388–93.

    Article  PubMed  CAS  Google Scholar 

  36. Mechanick JI, Youdim A, Jones DB, et al. American Association of Clinical Endocrinologists; Obesity Society; American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.

    Article  CAS  Google Scholar 

  37. De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of obesity and metabolic disorders (IFSO). Obes Surg. 2016;26(8):1659–96.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015;11(8):465–77.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore

    Marc Weijie Ong, Chun Hai Tan & Anton Kui Sing Cheng

Authors
  1. Marc Weijie Ong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chun Hai Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anton Kui Sing Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Weijie Ong.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ong, M.W., Tan, C.H. & Cheng, A.K.S. Prevalence and Determinants of Vitamin D Deficiency Among the Overweight and Obese Singaporeans Seeking Weight Management Including Bariatric Surgery: a Relationship with Bone Health. OBES SURG 28, 2305–2312 (2018). https://doi.org/10.1007/s11695-018-3142-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3142-y

Keywords

Search

Navigation