, Volume 51, Issue 2, pp 342–350 | Cite as

Longitudinal associations between lifestyle and vitamin D: A general population study with repeated vitamin D measurements

  • Tea SkaabyEmail author
  • Lise Lotte Nystrup Husemoen
  • Betina Heinsbæk Thuesen
  • Charlotta Pisinger
  • Anke Hannemann
  • Torben Jørgensen
  • Allan Linneberg
Original Article


Several lifestyle factors have been found to be associated with vitamin D status in cross-sectional studies, but it is not clear whether a change in these factors can actually affect the vitamin D level. We investigated the association between repeated measurements of physical activity, body mass index (BMI), diet, alcohol consumption, and smoking habits, and corresponding levels of vitamin D during 5 years of follow-up of a large general population sample. We included 4185 persons who participated and had vitamin D (serum-25-hydroxyvitamin D, 25-OH-D) measurements in the Inter99 study at baseline (1999–2001) and 5-year follow-up. In a subsample, 25-OH-D was also measured at 1- and 3-year follow-ups. We used mixed models to examine the association between repeated measurements of lifestyle factors and 25-OH-D levels. In multivariable analyses of repeated measurements, the difference in 25-OH-D was −0.32 ng/ml (95 % CI −0.37, −0.28) per 1 kg/m2 increase in BMI; 4.50 ng/ml (95 % CI 3.84, 5.15) for persons moderately/vigorously physically active versus sedentary; 1.82 ng/ml (95 % CI 1.09, 2.56) for persons with healthy versus unhealthy dietary habits; 0.05 ng/ml (95 % CI 0.03, 0.07) per 1 standard drink/weak increase in alcohol consumption; and 0.86 ng/ml (95 % CI 0.36, 1.35) for never smokers versus daily smokers. Our study shows that lower BMI, a higher level of physical activity, a healthier diet and possibly a higher alcohol intake, and not smoking, are associated with higher 25-OH-D levels.


Vitamin D Obesity Physical activity Smoking Alcohol Diet 



The present study was financially supported by the Health Insurance Foundation (Grant No. 2010 B 131). We would like to thank the participants and all members of the Inter99 staff at Research Centre for Prevention and Health. The Inter99 study was initiated by Torben Jørgensen, DMSci (principal investigator); Knut Borch-Johnsen, DMSci, (co-principal investigator); Troels Thomsen, PhD; and Hans Ibsen, DMSci. The Steering Committee comprises Torben Jørgensen and Charlotta Pisinger, PhD, MPH.

Conflict of interest

The authors declare that they have no conflict of interest

Ethical standards

The study was approved by the local Ethics Committees and the Danish Data Protection Agency, participants gave their informed written consent, and the recommendations of the Declaration of Helsinki were followed.


  1. 1.
    J. Hilger, A. Friedel, R. Herr, T. Rausch, F. Roos, D.A. Wahl et al., A systematic review of vitamin D status in populations worldwide. Br. J. Nutr. 111, 23–45 (2013)CrossRefPubMedGoogle Scholar
  2. 2.
    M.F. Holick, Vitamin D deficiency. N. Engl. J. Med. 357, 266–281 (2007)CrossRefPubMedGoogle Scholar
  3. 3.
    T. Skaaby, L.L. Husemoen, C. Pisinger, T. Jorgensen, B.H. Thuesen, M. Fenger et al., Vitamin D status and cause-specific mortality: a general population study. PLoS ONE 7, e52423 (2012)CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    T. Skaaby, L.L. Husemoen, B.H. Thuesen, C. Pisinger, T. Jorgensen, N. Roswall et al., Prospective population-based study of the association between serum 25-hydroxyvitamin-D levels and the incidence of specific types of cancer. Cancer Epidemiol. Biomarkers Prev. 23, 1220–1229 (2014)CrossRefPubMedGoogle Scholar
  5. 5.
    T. Skaaby, The relationship of vitamin D status to risk of cardiovascular disease and mortality. Dan. Med. J. 61, 2 (2015)Google Scholar
  6. 6.
    T. Skaaby, L. Husemoen, B. Thuesen, A. Linneberg, Prospective population-based study of the association between vitamin D status and incidence of autoimmune disease. Endocrine (2015). doi: 10.1007/s12020-015-0547-4 Google Scholar
  7. 7.
    E. Theodoratou, I. Tzoulaki, L. Zgaga, J.P. Ioannidis, Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 348, g2035 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    L.L. Husemoen, T. Skaaby, B.H. Thuesen, T. Jorgensen, R.V. Fenger, A. Linneberg, Serum 25(OH)D and incident type 2 diabetes: a cohort study. Eur. J. Clin. Nutr. 66, 1309–1314 (2012)CrossRefPubMedGoogle Scholar
  9. 9.
    T. Skaaby, L.L. Husemoen, C. Pisinger, T. Jorgensen, B.H. Thuesen, M. Fenger et al., Vitamin D status and changes in cardiovascular risk factors: a prospective study of a general population. Cardiology. 123, 62–70 (2012)CrossRefPubMedGoogle Scholar
  10. 10.
    T. Skaaby, L.L. Husemoen, T. Martinussen, J.P. Thyssen, M. Melgaard, B.H. Thuesen et al., Vitamin D status, filaggrin genotype, and cardiovascular risk factors: a Mendelian randomization approach. PLoS ONE 8, e57647 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    T. Skaaby, L.L. Husemoen, C. Pisinger, T. Jorgensen, B.H. Thuesen, K. Rasmussen et al., Vitamin D status and 5-year changes in urine albumin creatinine ratio and parathyroid hormone in a general population. Endocrine 44, 473–480 (2013)CrossRefPubMedGoogle Scholar
  12. 12.
    T. Skaaby, L.L. Husemoen, C. Pisinger, T. Jorgensen, B.H. Thuesen, M. Fenger et al., Vitamin D status and incident cardiovascular disease and all-cause mortality: a general population study. Endocrine 43, 618–625 (2013)CrossRefPubMedGoogle Scholar
  13. 13.
    T. Skaaby, L.L. Husemoen, B.H. Thuesen, C. Pisinger, T. Jorgensen, R.V. Fenger et al., Vitamin D status and chronic obstructive pulmonary disease: a prospective general population study. PLoS ONE 9, e90654 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    L. Yin, J.M. Ordonez-Mena, T. Chen, B. Schottker, V. Arndt, H. Brenner, Circulating 25-hydroxyvitamin D serum concentration and total cancer incidence and mortality: a systematic review and meta-analysis. Prev. Med. 57, 753–764 (2013)CrossRefPubMedGoogle Scholar
  15. 15.
    E. Klingberg, G. Olerod, J. Konar, M. Petzold, O. Hammarsten, Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Endocrine (2015). doi: 10.1007/s12020-015-0548-3 PubMedPubMedCentralGoogle Scholar
  16. 16.
    K. Brock, W.Y. Huang, D.R. Fraser, L. Ke, M. Tseng, R. Stolzenberg-Solomon et al., Low vitamin D status is associated with physical inactivity, obesity and low vitamin D intake in a large US sample of healthy middle-aged men and women. J. Steroid Biochem. Mol. Biol. 121, 462–466 (2010)CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    L.S. Greene-Finestone, C. Berger, M. de Groh, D.A. Hanley, N. Hidiroglou, K. Sarafin et al., 25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates. Osteoporos. Int. 22, 1389–1399 (2011)CrossRefPubMedGoogle Scholar
  18. 18.
    B. Hintzpeter, G.B. Mensink, W. Thierfelder, M.J. Muller, C. Scheidt-Nave, Vitamin D status and health correlates among German adults. Eur. J. Clin. Nutr. 62, 1079–1089 (2008)CrossRefPubMedGoogle Scholar
  19. 19.
    V. Hirani, A. Mosdol, G. Mishra, Predictors of 25-hydroxyvitamin D status among adults in two British national surveys. Br. J. Nutr. 101, 760–764 (2009)CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    M.A. Levy, T. McKinnon, T. Barker, A. Dern, T. Helland, J. Robertson et al., Predictors of vitamin D status in subjects that consume a vitamin D supplement. Eur. J. Clin. Nutr. 69, 84–89 (2015)CrossRefPubMedGoogle Scholar
  21. 21.
    J.A. Pasco, M.J. Henry, G.C. Nicholson, S.L. Brennan, M.A. Kotowicz, Behavioural and physical characteristics associated with vitamin D status in women. Bone 44, 1085–1091 (2009)CrossRefPubMedGoogle Scholar
  22. 22.
    B.H. Thuesen, T. Skaaby, L.L. Husemoen, M. Fenger, T. Jorgensen, A. Linneberg, The association of serum 25-OH vitamin D with atopy, asthma, and lung function in a prospective study of Danish adults. Clin. Exp. Allergy 45, 265–272 (2015)CrossRefPubMedGoogle Scholar
  23. 23.
    B. Thuesen, L. Husemoen, M. Fenger, J. Jakobsen, P. Schwarz, U. Toft et al., Determinants of vitamin D status in a general population of Danish adults. Bone 50, 605–610 (2012)CrossRefPubMedGoogle Scholar
  24. 24.
    T. Jorgensen, K. Borch-Johnsen, T.F. Thomsen, H. Ibsen, C. Glumer, C. Pisinger, A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: baseline results Inter99. Eur. J. Cardiovasc. Prev. Rehabil. 10, 377–386 (2003)CrossRefPubMedGoogle Scholar
  25. 25.
    U. Toft, L. Kristoffersen, S. Ladelund, A. Bysted, J. Jakobsen, C. Lau et al., Relative validity of a food frequency questionnaire used in the Inter99 study. Eur. J. Clin. Nutr. 62, 1038–1046 (2008)CrossRefPubMedGoogle Scholar
  26. 26.
    A. Ramnemark, M. Norberg, U. Pettersson-Kymmer, M. Eliasson, Adequate vitamin D levels in a Swedish population living above latitude 63 degrees N: The 2009 Northern Sweden MONICA study. Int. J. Circumpolar. Health. 74, 27963 (2015)CrossRefPubMedGoogle Scholar
  27. 27.
    A.J. Voipio, K.A. Pahkala, J.S. Viikari, V. Mikkila, C G. Magnussen, N. Hutri-Kahonen et al., Determinants of serum 25(OH)D concentration in young and middle-aged adults. The Cardiovascular Risk in Young Finns Study. Ann Med. 1–10 (2015). doi: 10.3109/07853890.2015.1020860
  28. 28.
    K.S. Vimaleswaran, D.J. Berry, C. Lu, E. Tikkanen, S. Pilz, L.T. Hiraki et al., Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 10, e1001383 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    A. Supervia, X. Nogues, A. Enjuanes, J. Vila, L. Mellibovsky, S. Serrano et al., Effect of smoking and smoking cessation on bone mass, bone remodeling, vitamin D, PTH and sex hormones. J. Musculoskelet. Neuronal. Interact. 6, 234–241 (2006)PubMedGoogle Scholar
  30. 30.
    E. Cutillas-Marco, A. Fuertes-Prosper, W.B. Grant, M. Morales-Suarez-Varela, Vitamin D deficiency in South Europe: effect of smoking and aging. Photodermatol. Photoimmunol. Photomed. 28, 159–161 (2012)CrossRefPubMedGoogle Scholar
  31. 31.
    K. Lee, Sex-specific relationships between alcohol consumption and vitamin D levels: The Korea National Health and Nutrition Examination Survey 2009. Nutr. Res. Pract. 6, 86–90 (2012)CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    T. Skaaby, L.L. Husemoen, A. Borglykke, T. Jorgensen, B.H. Thuesen, C. Pisinger et al., Vitamin D status, liver enzymes, and incident liver disease and mortality: a general population study. Endocrine 47, 213–220 (2013)CrossRefPubMedGoogle Scholar
  33. 33.
    T. Skaaby, L.L. Husemoen, A. Linneberg, Does liver damage explain the inverse association between vitamin D status and mortality? Ann. Epidemiol. 23, 812–814 (2013)CrossRefPubMedGoogle Scholar
  34. 34.
    M. Gascon-Barre, Interrelationships between vitamin D3 and 25-hydroxyvitamin D3 during chronic ethanol administration in the rat. Metabolism. 31, 67–72 (1982)CrossRefPubMedGoogle Scholar
  35. 35.
    R.T. Turner, R.C. Aloia, L.D. Segel, K.S. Hannon, N.H. Bell, Chronic alcohol treatment results in disturbed vitamin D metabolism and skeletal abnormalities in rats. Alcohol. Clin. Exp. Res. 12, 159–162 (1988)CrossRefPubMedGoogle Scholar
  36. 36.
    J.P. McClung, E. Gaffney-Stomberg, J.J. Lee, Female athletes: a population at risk of vitamin and mineral deficiencies affecting health and performance. J. Trace Elem. Med Biol. 28, 388–392 (2014)CrossRefPubMedGoogle Scholar
  37. 37.
    A.C. Ellis, J.A. Alvarez, B.A. Gower, G.R. Hunter, Cardiorespiratory fitness in older adult women: relationships with serum 25-hydroxyvitamin D. Endocrine 47, 839–844 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    M. Jenab, S. Salvini, C.H. van Gils, M. Brustad, S. Shakya-Shrestha, B. Buijsse et al., Dietary intakes of retinol, beta-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort. Eur. J. Clin. Nutr. 63(Suppl 4), S150–S178 (2009)CrossRefPubMedGoogle Scholar
  39. 39.
    M.F. Holick, N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney et al., Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 1911–1930 (2011)CrossRefPubMedGoogle Scholar
  40. 40.
    Z. Lagunova, A.C. Porojnicu, L. Aksnes, M.F. Holick, V. Iani, O.S. Bruland et al., Effect of vitamin D supplementation and ultraviolet B exposure on serum 25-hydroxyvitamin D concentrations in healthy volunteers: a randomized, crossover clinical trial. Br. J. Dermatol. 169, 434–440 (2013)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Tea Skaaby
    • 1
    Email author
  • Lise Lotte Nystrup Husemoen
    • 1
  • Betina Heinsbæk Thuesen
    • 1
  • Charlotta Pisinger
    • 1
  • Anke Hannemann
    • 2
  • Torben Jørgensen
    • 1
    • 3
    • 4
  • Allan Linneberg
    • 1
    • 5
    • 3
  1. 1.Research Centre for Prevention and HealthCapital Region of DenmarkCopenhagenDenmark
  2. 2.Institute of Clinical Chemistry and Laboratory MedicineUniversity Medicine GreifswaldGreifswaldGermany
  3. 3.Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
  4. 4.Faculty of MedicineAlborg UniversityAalborgDenmark
  5. 5.Department of Clinical Experimental ResearchRigshospitaletGlostrupDenmark

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