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

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Abstract

The aim of this study was to investigate modifiable predictors of vitamin D status in healthy individuals, aged 55–74, and living across the USA. Vitamin D status [serum 25-hydroxyvitamin D (25(OH)D)] was measured along with age and season at blood collection, demographics, anthropometry, physical activity (PA), diet, and other lifestyle factors in 1357 male and 1264 female controls selected from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) cohort. Multivariate linear and logistic regression analyses were used to identify associations with vitamin D status. Three%, 29% and 79% of the population had serum 25(OH)D levels <25, <50 and <80 nmol/L, respectively. The major modifiable predictors of low vitamin D status were low vitamin D dietary and supplement intake, body mass index (BMI) >30 kg/m2, physical inactivity (PA) and low milk and calcium supplement intake. In men, 25(OH)D was determined more by milk intake on cereal and in women, by vitamin D and calcium supplement and menopausal hormone therapy (MHT) use. Thus targeting an increase in vigorous activity and vitamin D and calcium intake and decreasing obesity could be public health interventions independent of sun exposure to improve vitamin D status in middle-aged Americans.

Introduction

Established determinants of vitamin D status, as measured by serum 25-hydroxyvitamin D (25(OH)D) are exposure to sunlight and intake of vitamin D, either from foods or vitamin supplements [1], [2], [3]. Decreased physical activity (PA) and obesity and low social status have also been associated with low vitamin D levels in Europe and the USA [4], [5], [6]. The aim of the present study was to investigate predictors of vitamin D status within a large non-elderly population of healthy men and women living across the USA.

Section snippets

Materials and methods

The subjects in this study were healthy controls, age-matched to case distributions, selected for five case–control studies of serum vitamin D and cancer nested within the original Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) cohort. The PLCO Cancer Screening Trial is a large randomized controlled multicenter trial in the United States of approximately 155 000 men and women at sites in Birmingham, AL; Denver, CO; Detroit, MI; Honolulu, HI; Marshfield, WI; Minneapolis, MN;

Results

Descriptive characteristics of the population by 25(OH)D level are presented in Table 1. There was very little overt clinical vitamin D deficiency in this study population, with only 3% of the population having serum 25(OH)D <25 nmol/L; 12%, 29%, 79% and 95% had levels of serum 25(OH)D <37 nmol/L, <50 nmol/L, <80 nmol/L, <100 nmol/L, respectively. The average age was 63 ± 5 years (males (M): 64 ± 5 years; females (F): 63 ± 5 years), 6% were of non-Caucasian origin, 8% were current smokers and 36% had

Discussion

Our observation that 25(OH)D serum levels are higher in summer and autumn than in winter and spring is consistent with studies where date of blood draw has been ascertained [17], [18]. Mean serum 25(OH)D levels in our study of middle-aged men and women (men = 60.8 nmol/L; women = 65.4 nmol/L) were similar to the overall mean data from the latest US National Health and Nutrition Examination Survey (men = 62.9 nmol/L; women = 61.5 nmol/L) [19] and higher than most European studies [20], [21], [22], [23], [24]

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