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

doi:10.1016/j.jsbmb.2010.03.091

The Journal of Steroid Biochemistry and Molecular Biology

Volume 121, Issues 1–2, July 2010, Pages 462-466

https://doi.org/10.1016/j.jsbmb.2010.03.091 Get rights and content

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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Adiposity and physical activity are among the main determinants of serum vitamin D concentrations in older adults: the EpiFloripa Aging Cohort Study
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The identification of factors associated with 25-hydroxycholecalciferol (25(OH)D) concentration can help suggest more specific interventions for older adults. In this cross-sectional study of older adults from southern Brazil, we hypothesized that some sociodemographic, behavioral, and health factors positively or negatively influence the 25(OH)D concentration in this population. This analysis was performed using data from the second wave of the EpiFloripa Aging Cohort Study (2013-2015). Serum 25(OH)D levels were classified according to the guidelines of the Endocrine Society. Multinomial logistic regression was performed to evaluate the relative risks of sociodemographic, behavioral, and health factors in each 25(OH)D category. A total of 574 older adults (aged 63-93 years) participated in this study. The prevalence of insufficiency (21-29 ng/mL) was 43.7% and that of deficiency (≤20 ng/mL) was 23.5%. In the adjusted analysis, female sex, higher levels of low-density lipoprotein cholesterol (LDL-C ≥160 mg/dL), obesity by adiposity (body fat percentage [%fat], male ≥31%; female ≥43%), and body mass index (BMI, >30 kg/m²) presented higher relative risks for insufficiency than for sufficiency. For those with deficiency, the associated factors were female sex, disability in 4 or more activities of daily living (ADLs), LDL-C ≥100 mg/dL, and obesity by %fat and BMI. A protective factor against insufficiency and deficiency was active leisure-time physical activity (PA, ≥150 min/week). Our results demonstrated that being female and having modifiable factors, such as high levels of LDL-C, obesity, and disability on ADLs, were negatively associated with hypovitaminosis D. On the other hand, leisure-time PA was positively associated with adequate serum vitamin D concentration.
Circulating 25-hydroxyvitamin D is associated with metabolic phenotypes of obesity: National Food and Nutrition Surveillance
2023, Nutrition Research
Different phenotypes of obesity are each related with different complications and comorbidities. We hypothesized that suboptimal vitamin D status is directly associated with an unhealthy metabolic status, especially if allied with obesity. This cross-sectional study was performed in the framework of the National Food and Nutrition Surveillance. Overall, 1098 men and women participated in this study. In addition to height and weight, serum concentrations of 25-hydroxyvitamin D (25(OH)D) and glycemic and lipidemic status were evaluated. Then participants were classified into 4 groups based on body mass index and lipidemic and glycemic profile status, as follows: hyperglycemic-dyslipidemic obese (HDO), hyperglycemic-dyslipidemic nonobese (HDNO), normoglycemic-normolipidemic obese (NNO), and normoglycemic-normolipidemic nonobese (NNNO). In this study, 31.6% of participants were classified as HDO, 7.5% as HDNO, 34.5% as NNO, and 26.4% as NNNO. The frequency of suboptimal vitamin D status was more prevalent in HDO (81.8%) than in other phenotypes (HDNO, 80%; NNO, 77.6%; NNNO, 73.8%; P = .015). In the multivariate model, suboptimal vitamin D status significantly increased the odds of being NNO (odds ratio [OR], 1.28; 95% CI, 0.84-1.95), HDNO (OR, 1.48; 95% CI, 0.77-2.83), and HDO (OR, 1.73; 95% CI, 1.11-2.7) compared with the NNNO group. Likewise, in multivariate model, per each unit (ng/mL) increment in 25(OH)D concentration, the odds of HDNO and HDO decreased significantly by 4% (OR, 0.96; 95% CI, 0.94-0.98) and 7% (OR, 0.93; 95% CI, 0.92-0.95), respectively. The results of the study showed a significant relationship between serum 25(OH)D concentrations and metabolic obesity phenotypes; these data confirm the association between suboptimal vitamin D status and metabolic complications, especially in obese individuals.
Vitamin D is associated with body composition and fat intake, but not with cardiometabolic parameters in adults with obesity
2022, Nutrition Research
Citation Excerpt :
Thus, it is suggested that there is no consensus in the literature regarding the independent effects of 25(OH)D and obesity on cardiometabolic parameters and it is noted that many other factors seem to influence these relationships. Therefore, further studies that, like this one, assess the interference of other confounding factors, such as skin color, 25(OH)D status (deficient, insufficient, and sufficient), and the level of physical activity [34] are needed to clarify these issues. In the present study, all individuals evaluated are inactive (inclusion criteria), which is a strong point of the study because the level of physical activity seems to interfere with 25(OH)D [34].
Adults with obesity are at higher risk for developing hypovitaminosis D. Some studies suggest that reduced levels of serum 25-hydroxyvitamin D (25(OH)D) may also be related to disorders in cardiometabolic parameters. However, because of the association between 25(OH)D and obesity, we hypothesized that body composition can be a confounding factor in the association of 25(OH)D with cardiometabolic parameters, and that 25(OH)D is inversely associated with body composition and cardiometabolic parameters and directly associated with fat intake. The aim of this study was to analyze the associations between 25(OH)D with body composition, fat intake, and cardiometabolic parameters in adults with obesity. This cross-sectional study consisted of 52 adults with obesity (61.53% female; 37.50 ± 6.88 years; body mass index [BMI]: 33.60 ± 2.89 kg/m²). Cardiometabolic parameters (fasting blood glucose, insulin resistance index, C-reactive protein, blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and cholesterol), body mass, BMI, waist circumference, body fat percentage, and fat intake were evaluated. Body mass was negatively associated with 25(OH)D (β = –0.108; P = .048; and R² = 0.090) and BMI (β = –0.621; P = .031; and R² = 0.103), both adjusted for fat intake. 25(OH)D was positively associated with fat intake (β = 0.129; P = .045 and R² = 0.078) adjusted for sex, age, and skin color. Cardiometabolic parameters were not associated with 25(OH)D, even after adjusted by body composition variables. However, the high prevalence of hypovitaminosis D (75%) and the negative association between 25(OH)D and body composition reinforce the importance of analyzing and monitoring vitamin D status in this population.
Association between physical activity and vitamin D is partially mediated by adiposity in older adults: EpiFloripa Aging Cohort Study
2022, Nutrition Research
Citation Excerpt :
Studies investigating the determinants of 25(OH)D in adults and older adults have found an association with PA as a protective factor for low 25(OH)D and BMI as a risk factor for low 25(OH)D [45,46]. In contrast, a sedentary lifestyle or insufficient PA is associated with an increased risk of low 25(OH)D [19,47]. Our data showed that for a 4.1 hours/wk increase in MVPA, there was a 1.02 ng/mL increase in 25(OH)D. Despite causing only a marginal increase, MVPA may affect 25(OH)D, contributing to maintenance of adequate serum status in the older adult population.
Studies have found that physical activity (PA) could be a protective factor and adiposity a risk factor for low serum 25-hydroxycholecalciferol (25(OH)D) concentration. This cross-sectional study hypothesized that PA could have a direct effect on 25(OH)D, and adiposity could be a mediating factor. Data from the second wave of the EpiFloripa Aging longitudinal study, collected during 2013 and 2014 (n = 1197) in Florianopolis, Santa Catarina, Brazil, was used. PA was measured using an accelerometer and classified as light PA (LPA), moderate and vigorous PA (MVPA), and total PA (TPA); 25(OH)D levels were measured using the microparticle chemiluminescence method. Body fat composition (%fat) was assessed using dual-energy X-ray absorptiometry. Structural equation modeling was performed to analyze the total, direct, and indirect effects of PA on %fat and 25(OH)D levels, presented using the standardized coefficient (β). Participants with complete data were included in the analysis (n = 574, 66.7% female). MVPA showed a direct (β = 0.11; P < .05) and total positive effect on 25(OH)D (β = 0.12; P < .05). All models of PA had a direct negative effect on %fat. Additionally, a direct negative effect of %fat on 25(OH)D was observed in all models. A marginal and partial effect of %fat as a mediator of the relationship between MVPA and 25(OH)D was noted (β = 0.01, P = .09). Our results show that PA presents a direct effect on serum 25(OH)D. %fat has a small contribution as a mediator of this relationship. These data suggest that an increase in MVPA and a decrease in %fat could be strategies to increase 25(OH)D levels in older adults.
Factors affecting vitamin D status in outpatients with abdominal aortic aneurysm and peripheral artery disease- a single centre study
2021, Nutrition, Metabolism and Cardiovascular Diseases
Vitamin D (VD) deficiency is considered an important risk factor for the development of atherosclerosis and aortic aneurysms. The deficiency is claimed to enhance degeneration and remodeling of collagen and elastin fibers in the artery wall, leading to its weakening and progressive dilatation.
This study aimed to assess vitamin D status, in outpatients with abdominal aneurysms (AAA) and peripheral artery disease (PAD) not treated with VD, and factors affecting serum 25-OH-D levels.
This cross-sectional study involved 59 outpatients with AAA and 150 with PAD. AAA was defined as local dilation of the aorta diameter >30 mm in imaging. None of the patients was prescribed VD containing medicines. Serum 25-OH, iPTH, phosphorus and calcium levels were assessed in all study participants. VD status was categorized according to commonly used cut-offs for serum 25-OH-D (<20 ng/mL – deficiency, <30 ng/mL –insufficiency). Serum 25-OH-D levels were similar in patient with AAA and PAD [1-3Q: 26.2 (18.8–37.6) vs 21.8 (15.9–31.4) ng/mL; p = 0.30], with deficiency noted in 25.4% with AAA and 41.8% with PAD (p < 0.05). Multiple regression analysis revealed that VD deficiency was explained by past stroke episodes [OR = 2.80 (95%CI: 1.22–6.41)]. Secondary hyperparathyroidism was diagnosed in 1.7% of patients with AAA and 1.9% with PAD.
The frequency of VD deficiency in outpatient with AAA is not greater than in those with PAD. Past stroke episode is associated with an increased occurrence of VD deficiency in both outpatients with AAA and PAD other than sun exposure and diet.
Relationship of sedentary time, physical activity and fitness with 1,25-dihydroxyvitamin D in middle-aged sedentary adults: The FIT-AGEING study
2021, Experimental Gerontology
Potential interactions between sedentary behaviour, physical activity (PA), and physical fitness with 25-hydroxyvitamin D (25(OH)D) status have been previously suggested. However, data are scarce concerning the association between these predictors of general health and the main active metabolite of vitamin D, the 1,25-dihidroxyvitamin D (1,25(OH)₂D). This study aimed to analyse the relationship of sedentary time, PA levels, and physical fitness (i.e., maximal oxygen uptake (VO₂max) and muscular strength) with 1,25(OH)₂D in middle-aged sedentary adults.
A total of 73 (39 women) middle-aged sedentary adults (53.7 ± 5.1 years old) participated in this cross-sectional study. Sedentary time and PA intensity levels were objectively measured with triaxial accelerometers for 7 consecutive days. VO₂max was determined by a maximum treadmill test. Lower and upper limb muscular strength was assessed by an isokinetic strength test and by a handgrip strength test, respectively. 1,25(OH)₂D plasma levels were measured using a DiaSorin Liaison® immunochemiluminometric assay.
No significant relationships were found between objectively measured sedentary time, PA levels or physical fitness (i.e., VO₂max, extension and flexion peak torque, and hand grip strength) and 1,25(OH)₂D (all P > 0.05). All results persisted after controlling for age, sex, fat mass or energy, vitamin D, calcium, and phosphorus intake.
In summary, our results show that vitamin D status is not affected by physical activity habits and sedentary behaviour in middle-aged sedentary adults.

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^☆: Special issue selected article from the 14th Vitamin D Workshop held at Brugge, Belgium on October 4–8, 2009.

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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☆

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Lancet

Prog. Biophys. Mol. Biol.

Control Clin. Trials

Clin. Biochem.

Am. J. Clin. Nutr.

Am. J. Clin. Nutr.

Am. J. Clin. Nutr.

J. Steroid Biochem. Mol. Biol.

Ann. Epidemiol.

Am. J. Clin. Nutr.

Vitamin D deficiency

NEJM

Vitamin D status among German adults

Eur. J. Nutr.

Predictors of 25-(OH)D status among adults in two British national surveys

Br. J. Nutr.

Prospective study of predictors of vitamin D status

J. Natl. Cancer Inst.

Circulating vitamin D metabolites, polymorphism in vitamin D receptor, and colorectal adenoma risk

Cancer Epidemiol. Biomark. Prev.