Background
Methods
Participants
Blood sample collection and measures of serum 25(OH)D
Outcomes
Nutrient intake assessments
Statistical analysis
Charactersa
| Normal, n = 6962 | Insufficiency, n = 3620 | Deficiency, n = 1575 |
Pvalueb
|
---|---|---|---|---|
Serum 25(OH)D (ng/ml), mean (SE) | 28.5 (0.2) | 16.1 (0.2) | 8.8 (0.1) | <0.001 |
Age (years), mean (SE) | 47.0 (0.4) | 46.7 (0.4) | 46.2 (0.6) | <0.001 |
Male, n (%) | 3711 (51.2) | 1833 (47.7) | 696 (38.4) | <0.001 |
Body mass index (kg/m2), mean (SE) | 27.3 (0.1) | 29.6 (0.2) | 31.5 (0.4) | <0.001 |
Month of blood collection, n (%) | ||||
1 November to 30 April (winter) | 2,688 (34.4) | 1,980 (50.7) | 999 (57.6) | <0.001 |
1 May to 31 October (summer) | 4,274 (65.6) | 1,640 (49.3) | 676 (42.4) | |
Education, n (%) | ||||
Less than high school | 1,694 (14.8) | 1,194 (21.8) | 621 (28.5) | <0.001 |
High school | 1,729 (25.3) | 872 (26.3) | 384 (25.4) | |
Greater than high school | 3,535 (59.9) | 1,550 (51.9) | 667 (46.1) | |
Race/ethnicity, n (%) | ||||
Non-Hispanic Caucasian | 4,812 (84.5) | 1,390 (59.5) | 316 (33.9) | <0.001 |
Non-Hispanic Black | 558 (3.5) | 965 (17.0) | 906 (44.8) | |
Hispanic | 1,394 (8.6) | 1,091 (16.5) | 394 (14.1) | |
Others | 198 (3.4) | 174 (7.1) | 59 (7.1) | |
Family poverty income ratio, n (%) | ||||
<1 | 929 (9.7) | 661 (15.6) | 358 (20.0) | <0.001 |
1 to 4 | 4,181 (61.5) | 2,230 (63.6) | 1,031 (65.7) | |
≥5 | 1,507 (28.8) | 516 (20.8) | 181 (14.3) | |
Smoker, n (%) | ||||
Non-smoker | 3,407 (49.5) | 1,856 (50.0) | 869 (50.0) | <0.001 |
Former smoker | 1,914 (24.8) | 833 (21.0) | 303 (16.3) | |
Current smoker | 1,637 (25.7) | 926 (29.0) | 500 (33.8) | |
Alcohol user, n (%) | ||||
Non-drinker | 784 (15.0) | 555 (21.5) | 293 (24.2) | <0.001 |
Former drinker | 559 (10.3) | 382 (14.3) | 187 (14.1) | |
Current drinker | 3,139 (74.8) | 1,452 (64.2) | 639 (61.7) | |
Physical activity during the day, n (%) | ||||
Sit and not walk about very much | 1,512 (21.2) | 960 (27.0) | 541 (32.9) | <0.001 |
Walk a lot | 3,584 (50.4) | 1,904 (50.5) | 857 (49.2) | |
Light work | 1,276 (20.5) | 497 (15.2) | 202 (13.9) | |
Heavy work | 582 (8.0) | 254 (7.3) | 73 (4.0) | |
Leisure time physical activity (Metabolic equivalent/h/week), mean (SE) | 1,292.4 (52.2) | 788.5 (55.6) | 674.2 (53.1) | <0.001 |
Users of supplement containing vitamin D (%) | 3,258 (47.2) | 1,018 (30.4) | 202 (12.5) | <0.001 |
Users of supplement containing Ca (%) | 3,860 (57.1) | 1,380 (42.6) | 351 (22.3) | <0.001 |
Users of supplement containing Mg (%) | 3,040 (45.1) | 1,072 (32.0) | 235 (14.9) | <0.001 |
Energy-adjusted nutrient intakesc, mean (SE) | ||||
Protein (g/day) | 82.0 (0.5) | 80.1 (0.7) | 77.8 (1.3) | <0.01 |
Carbohydrate (g/day) | 258.5 (1.4) | 262.4 (1.7) | 261.6 (2.9) | 0.135 |
Fat (g/day) | 80.7 (0.5) | 80.3 (0.6) | 81.2 (0.9) | 0.93 |
Calcium (mg/day) | 929.0 (8.4) | 805.2 (9.1) | 690.3 (13.6) | <0.001 |
Magnesium (mg/day) | 293.1 (2.2) | 266.6 (2.9) | 252.4 (4.2) | <0.001 |
Vitamin D (IU/day) | 196 (8.0) | 160 (8.0) | 116 (8.0) | <0.001 |
Total calcium (mg/day)d
| 1,168.8 (12.6) | 935.4 (12.3) | 748.5 (15.9) | <0.001 |
Total magnesium (mg/day)d
| 344.2 (3.5) | 297.3 (3.2) | 262.4 (4.4) | <0.001 |
Total vitamin D (IU/day)d
| 376 (8.0) | 276 (8.0) | 152 (8.0) | <0.001 |
Nutrient intakes | Controls, N | Deficiency | Insufficiency | ||
---|---|---|---|---|---|
N | OR (95% CI) | N | OR (95% CI) | ||
Total vitamin D intake (IU/day) | |||||
Q1 <114 | 1,741 | 1,005 | 1.00 | 1,450 | 1.00 |
Q2 114 to 307 | 1,740 | 446 | 0.55 (0.40 to 0.75) | 1,086 | 0.75 (0.62 to 0.91) |
Q3 308 to 539 | 1,741 | 152 | 0.22 (0.15 to 0.34) | 665 | 0.55 (0.44 to 0.69) |
Q4 ≥540 | 1,740 | 72 | 0.10 (0.06 to 0.17) | 419 | 0.37 (0.27 to 0.51) |
P for trend | <0.001 | <0.001 | |||
Dietary vitamin D intake (IU/day) | |||||
Q1 <57.8 | 1,741 | 764 | 1.00 | 1,183 | 1.00 |
Q2 57.8 to 137 | 1,740 | 468 | 0.71 (0.55 to 0.91) | 997 | 0.86 (0.71 to 1.05) |
Q3 138 to 261 | 1,741 | 279 | 0.54 (0.40 to 0.72) | 807 | 0.72 (0.59 to 0.88) |
Q4 ≥262 | 1,740 | 164 | 0.29 (0.20 to 0.41) | 633 | 0.69 (0.56 to 0.86) |
P for trend | <0.001 | <0.001 | |||
Supplemental vitamin D intake (IU/day) | |||||
Non-user | 3,704 | 1,473 | 1.00 | 2,602 | 1.00 |
1 to 239 | 809 | 93 | 0.32 (0.20 to 0.50) | 377 | 0.84 (0.68 to 1.03) |
240 to 399 | 331 | 19 | 0.29 (0.13 to 0.64) | 109 | 0.57 (0.38 to 0.87) |
≥400 | 2,118 | 90 | 0.19 (0.11 to 0.33) | 532 | 0.40 (0.29 to 0.53) |
P for trend | <0.001 | <0.001 | |||
Total magnesium intake (mg/day) | |||||
Q1 <225 | 1,749 | 876 | 1.00 | 1,362 | 1.00 |
Q2 225 to 310 | 1,733 | 392 | 0.67 (0.50 to 0.90) | 907 | 0.78 (0.61 to 1.00) |
Q3 311 to 419 | 1,737 | 245 | 0.43 (0.30 to 0.63) | 758 | 0.73 (0.59 to 0.89) |
Q4 ≥420 | 1,743 | 162 | 0.34 (0.21 to 0.56) | 593 | 0.62 (0.46 to 0.82) |
P for trend | <0.001 | <0.001 | |||
Dietary magnesium intake (mg/day) | |||||
Q1 <195 | 1,754 | 726 | 1.00 | 1,255 | 1.00 |
Q2 195 to 268 | 1,732 | 432 | 0.75 (0.58 to 0.97) | 893 | 0.75 (0.62 to 0.90) |
Q3 269 to 363 | 1,741 | 297 | 0.68 (0.47 to 0.99) | 777 | 0.69 (0.55 to 0.87) |
Q4 ≥364 | 1,735 | 220 | 0.43 (0.26 to 0.70) | 695 | 0.61 (0.45 to 0.83) |
P for trend | 0.002 | 0.002 | |||
Supplemental magnesium intake (mg/day) | |||||
Non-user | 3,922 | 1,440 | 1.00 | 2,548 | 1.00 |
1 to 49 | 669 | 109 | 0.53 (0.34 to 0.81) | 334 | 1.14 (0.91 to 1.43) |
50 to 99 | 506 | 43 | 0.35 (0.17 to 0.71) | 205 | 0.80 (0.53 to 1.22) |
≥100 | 1,865 | 83 | 0.30 (0.17 to 0.52) | 533 | 0.68 (0.52 to 0.88) |
P for trend | <0.001 | 0.008 |
Magnesium intake, mg/day | Controls, N | Deficiency | Insufficiency | ||
---|---|---|---|---|---|
N | OR (95% CI) | N | OR (95% CI) | ||
Vitamin D intake <308 (IU/day) | |||||
Q1 <225 | 1,359 | 834 | 1.00 | 1,218 | 1.00 |
Q2 225 to 310 | 940 | 328 | 0.79 (0.58 to 1.07) | 650 | 0.89 (0.69 to 1.15) |
Q3 311 to 419 | 697 | 184 | 0.64 (0.46 to 0.91) | 426 | 0.78 (0.63 to 1.08) |
Q4 ≥420 | 485 | 105 | 0.58 (0.35 to 0.97) | 242 | 0.71 (0.47 to 1.07) |
P for trend | 0.01 | <0.05 | |||
Vitamin D intake ≥308 (IU/day) | |||||
Q1 <225 | 390 | 42 | 1.00 | 144 | 1.00 |
Q2 225 to 310 | 793 | 64 | 1.09 (0.47 to 2.55) | 257 | 0.94 (0.62 to 1.42) |
Q3 311 to 419 | 1,040 | 61 | 0.76 (0.30 to 1.88) | 332 | 1.19 (0.80 to 1.77) |
Q4 ≥420 | 1,258 | 57 | 0.71 (0.24 to 2.11) | 351 | 0.96 (0.60 to 1.55) |
P for trend | 0.97 | 0.67 | |||
P for interaction | <0.001 | <0.001 | |||
Non-vitamin D supplement user | |||||
Q1 <225 | 1,292 | 812 | 1.00 | 1,160 | 1.00 |
Q2 225 to 310 | 958 | 332 | 0.81 (0.57 to 1.14) | 651 | 0.91 (0.70 to 1.18) |
Q3 311 to 419 | 793 | 205 | 0.59 (0.40 to 0.88) | 462 | 0.80 (0.63 to 1.02) |
Q4 ≥420 | 661 | 124 | 0.60 (0.35 to 1.00) | 329 | 0.81 (0.55 to 1.19) |
P for trend | 0.02 | 0.18 | |||
Vitamin D supplement user | |||||
Q1 <225 | 457 | 64 | 1.00 | 202 | 1.00 |
Q2 225 to 310 | 775 | 60 | 1.23 (0.59 to 2.56) | 256 | 0.80 (0.53 to 1.20) |
Q3 311 to 419 | 944 | 40 | 1.05 (0.41 to 1.68) | 296 | 0.96 (0.65 to 1.41) |
Q4 ≥420 | 1,082 | 38 | 0.91 (0.35 to 2.36) | 264 | 0.73 (0.49 to 1.10) |
P for trend | 0.56 | 0.40 | |||
P for interaction | 0.47 | 0.37 | |||
Winter and Southern latitude | |||||
Q1 <225 | 664 | 493 | 1.00 | 726 | 1.00 |
Q2 225 to 310 | 691 | 239 | 0.63 (0.47 to 0.85) | 495 | 0.73 (0.57 to 0.92) |
Q3 311 to 419 | 653 | 156 | 0.49 (0.30 to 0.78) | 422 | 0.89 (0.74 to 1.07) |
Q4 ≥420 | 680 | 111 | 0.54 (0.28 to 1.02) | 337 | 0.57 (0.41 to 0.78) |
P for trend | 0.03 | <0.01 | |||
Summer and Northern latitude | |||||
Q1 <225 | 1,085 | 383 | 1.00 | 636 | 1.00 |
Q2 225 to 310 | 1,042 | 153 | 0.95 (0.64 to 1.41) | 412 | 0.91 (0.66 to 1.26) |
Q3 311 to 419 | 1,084 | 89 | 0.61 (0.43 to 0.86) | 336 | 0.73 (0.56 to 0.96) |
Q4 ≥420 | 1,063 | 51 | 0.33 (0.20 to 0.55) | 256 | 0.85 (0.61 to 1.19) |
P for trend | 0.001 | 0.35 | |||
P for interaction | 0.55 | 0.21 | |||
Age <50 (years) | |||||
Q1 <225 | 862 | 465 | 1.00 | 726 | 1.00 |
Q2 225 to 310 | 821 | 209 | 0.74 (0.49 to 1.11) | 495 | 0.83 (0.60 to 1.16) |
Q3 311 to 419 | 831 | 150 | 0.63 (0.35 to 1.13) | 422 | 0.84 (0.62 to 1.13) |
Q4 ≥420 | 892 | 110 | 0.67 (0.32 to 1.42) | 337 | 0.73 (0.50 to 1.08) |
P for trend | 0.26 | 0.15 | |||
Age ≥50 (years) | |||||
Q1 <225 | 1,085 | 383 | 1.00 | 636 | 1.00 |
Q2 225 to 310 | 1,042 | 153 | 0.85 (0.50 to 1.37) | 412 | 0.86 (0.63 to 1.16) |
Q3 311 to 419 | 1,084 | 89 | 0.43 (0.24 to 0.77) | 336 | 0.79 (0.57 to 1.10) |
Q4 ≥420 | 1,063 | 51 | 0.24 (0.11 to 0.49) | 256 | 0.71 (0.46 to 1.10) |
P for trend | <0.01 | 0.81 | |||
P for interaction | 0.07 | 0.41 | |||
Male | |||||
Q1 <225 | 712 | 283 | 1.00 | 519 | 1.00 |
Q2 225 to 310 | 854 | 164 | 0.64 (0.41 to 1.00) | 466 | 1.12 (0.78 to 1.61) |
Q3 311 to 419 | 995 | 143 | 0.39 (0.21 to 0.74) | 439 | 0.90 (0.65 to 1.26) |
Q4 ≥420 | 1,150 | 106 | 0.33 (0.16 to 0.69) | 409 | 0.95 (0.59 to 1.52) |
P for trend | 0.001 | 0.54 | |||
Female | |||||
Q1 <225 | 1,037 | 593 | 1.00 | 843 | 1.00 |
Q2 225 to 310 | 879 | 228 | 0.85 (0.61 to 1.21) | 441 | 0.71 (0.54 to 0.93) |
Q3 311 to 419 | 742 | 102 | 0.63 (0.37 to 1.05) | 319 | 0.83 (0.64 to 1.07) |
Q4 ≥420 | 593 | 56 | 0.47 (0.25 to 0.87) | 184 | 0.60 (0.43 to 0.82) |
P for trend | 0.16 | 0.14 | |||
P for interaction | 0.11 | 0.17 | |||
Non-Hispanic Black | |||||
Q1 <225 | 181 | 530 | 1.00 | 442 | 1.00 |
Q2 225 to 310 | 163 | 181 | 0.51 (0.34 to 0.76) | 229 | 0.74 (0.53 to 1.03) |
Q3 311 to 419 | 110 | 115 | 0.44 (0.26 to 0.74) | 175 | 0.53 (0.33 to 0.88) |
Q4 ≥420 | 104 | 81 | 0.43 (0.27 to 0.68) | 119 | 0.64 (0.39 to 1.04) |
P for trend | <0.001 | <0.05 | |||
Non-Hispanic Caucasian and others | |||||
Q1 <225 | 1,568 | 346 | 1.00 | 920 | 1.00 |
Q2 225 to 310 | 1,570 | 212 | 0.91 (0.65 to 1.28) | 678 | 0.86 (0.67 to 1.10) |
Q3 311 to 419 | 1,627 | 130 | 0.66 (0.45 to 0.97) | 583 | 0.87 (0.67 to 1.10) |
Q4 ≥420 | 1,639 | 81 | 0.52 (0.29 to 0.95) | 474 | 0.76 (0.58 to 0.99) |
P for trend | <0.05 | 0.27 | |||
P for interaction | 0.305 | 0.82 | |||
BMI <25 (kg/m2) | |||||
Q1 <225 | 631 | 172 | 1.00 | 336 | 1.00 |
Q2 225 to 310 | 611 | 90 | 1.04 (0.51 to 2.12) | 339 | 0.92 (0.61 to 1.40) |
Q3 311 to 419 | 606 | 58 | 0.84 (0.40 to 1.76) | 189 | 1.00 (0.70 to 1.44) |
Q4 ≥420 | 608 | 41 | 0.51 (0.23 to 1.15) | 162 | 0.77 (0.47 to 1.27) |
P for trend | 0.13 | 0.45 | |||
BMI ≥25 to <30 (kg/m2) | |||||
Q1 <225 | 605 | 232 | 1.00 | 448 | 1.00 |
Q2 225 to 310 | 632 | 106 | 0.71 (0.43 to 1.15) | 316 | 0.77 (0.51 to 1.17) |
Q3 311 to 419 | 661 | 75 | 0.50 (0.29 to 0.86) | 266 | 0.63 (0.50 to 0.79) |
Q4 ≥420 | 677 | 46 | 0.47 (0.22 to 1.01) | 213 | 0.73 (0.48 to 1.13) |
P for trend | 0.02 | 0.06 | |||
BMI ≥30 (kg/m2) | |||||
Q1 <225 | 463 | 440 | 1.00 | 532 | 1.00 |
Q2 225 to 310 | 457 | 177 | 0.63 (0.35 to 1.14) | 341 | 0.82 (0.63 to 1.06) |
Q3 311 to 419 | 441 | 108 | 0.46 (0.24 to 0.88) | 288 | 0.83 (0.59 to 1.15) |
Q4 ≥420 | 424 | 69 | 0.42 (0.19 to 0.96) | 202 | 0.63 (0.44 to 0.91) |
P for trend | 0.02 | 0.02 | |||
P for interaction | 0.23 | 0.13 | |||
PTH <32 (pg/ml) | |||||
Q1 <225 | 322 | 63 | 1.00 | 179 | 1.00 |
Q2 225 to 310 | 369 | 39 | 0.42 (0.18 to 1.02) | 109 | 0.72 (0.42 to 1.24) |
Q3 311 to 419 | 363 | 21 | 0.17 (0.07 to 0.43) | 107 | 0.77 (0.47 to 1.28) |
Q4 ≥420 | 392 | 19 | 0.22 (0.07 to 0.73) | 100 | 0.74 (0.38 to 1.42) |
P for trend | <0.01 | 0.46 | |||
PTH ≥32 to <46 (pg/ml) | |||||
Q1 <225 | 378 | 136 | 1.00 | 271 | 1.00 |
Q2 225 to 310 | 382 | 66 | 1.20 (0.66 to 2.21) | 195 | 0.94 (0.73 to 1.22) |
Q3 311 to 419 | 406 | 54 | 1.19 (0.53 to 2.66) | 181 | 0.85 (0.59 to 1.23) |
Q4 ≥420 | 414 | 33 | 1.11 (0.36 to 3.42) | 131 | 0.79 (0.55 to 1.15) |
P for trend | 0.85 | 0.24 | |||
PTH ≥46 (pg/ml) | |||||
Q1 <225 | 390 | 375 | 1.00 | 447 | 1.00 |
Q2 225 to 310 | 382 | 157 | 0.73 (0.48 to 1.10) | 297 | 0.93 (0.68 to 1.28) |
Q3 311 to 419 | 382 | 95 | 0.52 (0.28 to 0.95) | 209 | 0.78 (0.60 to 1.01) |
Q4 ≥420 | 365 | 50 | 0.28 (0.14 to 0.53) | 159 | 0.57 (0.35 to 0.92) |
P for trend | 0.01 | 0.41 | |||
P for interaction | 0.73 | 0.53 |
Magnesium intake (mg/day) | Serum vitamin D level (ng/ml) |
Pfor trend | ||||
---|---|---|---|---|---|---|
<20 | 20 to 31 | 32 to 39 | ≥40 | |||
Total mortality | ||||||
Total | Cases | 1,274 | 1,547 | 558 | 324 | |
HR (95% CI) | 1.00 | 0.83 (0.74 to 0.94) | 0.80 (0.69 to 0.93) | 0.79 (0.66 to 0.93) | <0.01 | |
<264 | Cases | 848 | 786 | 249 | 143 | |
HR (95% CI) | 1.00 | 0.89 (0.74 to 1.08) | 0.87 (0.69 to 1.08) | 0.87 (0.64 to 1.20) | 0.23 | |
≥264 | Cases | 426 | 761 | 309 | 181 | |
HR (95% CI) | 1.00 | 0.77 (0.64 to 0.92) | 0.73 (0.58 to 0.93) | 0.70 (0.57 to 0.88) | <0.01 | |
P for interaction | 0.96 | |||||
Cardiovascular mortality | ||||||
Total | Cases | 574 | 656 | 253 | 132 | |
HR (95% CI) | 1.00 | 0.73 (0.62 to 0.86) | 0.77 (0.61 to 0.99) | 0.73 (0.56 to 0.97) | 0.04 | |
<264 | Cases | 386 | 346 | 112 | 57 | |
HR (95% CI) | 1.00 | 0.83 (0.66 to 1.04) | 0.88 (0.61 to 1.28) | 0.91 (0.61 to 1.35) | 0.45 | |
≥264 | Cases | 188 | 310 | 141 | 75 | |
HR (95% CI) | 1.00 | 0.59 (0.44 to 0.80) | 0.65 (0.44 to 0.95) | 0.57 (0.38 to 0.87) | <0.05 | |
P for interaction | 0.03 | |||||
Colorectal cancer mortality | ||||||
Total | Cases | 32 | 34 | 12 | 8 | |
HR (95% CI) | 1.00 | 0.84 (0.36 to 2.00) | 0.80 (0.31 to 2.05) | 0.50 (0.15 to 1.73) | 0.31 | |
<264 | Cases | 19 | 17 | 3 | 3 | |
HR (95% CI) | 1.00 | 1.17 (0.39 to 3.56) | 0.79 (0.17 to 3.75) | 0.85 (0.17 to 4.12) | 0.73 | |
≥264 | Cases | 13 | 17 | 9 | 5 | |
HR (95% CI) | 1.00 | 0.55 (0.16 to 1.85) | 0.67 (0.17 to 2.64) | 0.28 (0.03 to 2.25) | 0.29 | |
P for interaction | 0.15 |