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Aspects of Vitamin D: Prevalence of deficiency and impact on musculoskeletal parameters
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
2017 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Vitamin D is central in calcium turnover, and adequate levels are important for skeletal health. It is not clear how large contributions from food and sunlight are in Swedish primary care patients, considering the low radiation of UVB in Sweden and fortification of some foods, and whether differences exist between patients of immigrant and Swedish origin. Increasing incidence of osteoporosis-related fractures is a major global health problem. Genetic variations in metabolising enzymes and in the Vitamin D receptor (VDR) have also been shown to be of importance to the overall effect of vitamin D. Polymorphic variation in the gene CYP2R1 encoding the 25-hydroxylase has previously been reported to correlate with circulating levels of 25(OH)D3. Results of association studies between genetic variants of the VDR and muscle strength, as well as falls have been contradictory.

The purposes of this thesis were to examine possible differences in plasma-25(OH)D3 levels and intake of vitamin D between Swedish and immigrant female primary care patients, to estimate what foods contribute the most, and to identify contributors to vitamin D status (Paper I-II). Furthermore, the relationship between polymorphisms in the CYP2R1 gene and levels of 25(OH)D3 as well as other biochemical parameters (parathyroid hormone, calcium, phosphate and fibroblast growth factor 23) of skeletal homeostasis, bone mineral density and incidence of fractures was investigated (Paper III). Also, the association between genetic variations in the gene for the vitamin D receptor and measures of muscle strength, physical performance and falls (Paper IV), was investigated by using data from a Swedish multicenter study of elderly men (MrOS).

Most important results: Vitamin D deficiency was common, with significant difference between Swedish born and immigrant patients (Paper I). Food intake of vitamin D is associated with circulating vitamin D, but the factors most strongly affecting vitamin D levels were reported sun holiday and origin (Paper II). CYP2R1 polymorphisms are associated with circulating levels of 25(OH)D3 and bone mineral density (Paper III). VDR genetic variants do not appear to have a direct effect on muscle strength or physical performance and incidence of falls in elderly Swedish men (Paper IV).

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2017. , 47 s.
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1313
Nyckelord [en]
Vitamin D, CYP2R1, Vitamin D receptor Gene, Polymorphisms, Muscle Strength
Nationell ämneskategori
Allmän medicin
Forskningsämne
Endokrinologi och Diabetologi
Identifikatorer
URN: urn:nbn:se:uu:diva-317315ISBN: 978-91-554-9852-8 (tryckt)OAI: oai:DiVA.org:uu-317315DiVA: diva2:1081230
Disputation
2017-05-04, A1:111a, Biomedicinskt centrum, Uppsala, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2017-04-12 Skapad: 2017-03-13 Senast uppdaterad: 2017-04-21
Delarbeten
1. Vitamin D intake and status in immigrant and native Swedish women: a study at a primary health care centre located at 60 degrees N in Sweden
Öppna denna publikation i ny flik eller fönster >>Vitamin D intake and status in immigrant and native Swedish women: a study at a primary health care centre located at 60 degrees N in Sweden
2013 (Engelska)Ingår i: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 57, UNSP 20089- s.Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Immigration to Sweden from lower latitude countries has increased in recent years. Studies in the general population in other Nordic countries have demonstrated that these groups are at risk of developing vitamin D deficiency, but studies in primary health care patients are rare. Objectives: The aim of this study is to examine possible differences in plasma-25(OH)-vitamin D levels and intake of vitamin D between Swedish and immigrant female patients in a primary health care centre located at 60 degrees N, where half of the inhabitants have an immigrant background. Another objective was to estimate what foods contribute with most vitamin D. Design: Thirty-one female patients from the Middle East and Africa and 30 from Sweden were recruited. P-25(OH)D was measured and intake of vitamin D was estimated with a modified food frequency questionnaire (FFQ). Results: Vitamin D deficiency (plasma-25(OH)D<25 nmol/L) was common among immigrant women (61%). One immigrant woman and half of the Swedish women had optimal levels (plasma-25(OH)D>50 nmol/L). There was a positive correlation between the intake of vitamin D from food and plasma-25(OH) D. Only three women, all Swedish, reached the recommended intake of vitamin D from food. The immigrant women had lower intake compared to Swedish women (median: 3.1 vs. 5.1 mu g/day). The foods that contributed with most vitamin D were fatty fish, fortified milk and margarine. Immigrant women consumed less fortified milk and margarine but more meat. Irrespective of origin, patients with plasma-25(OH)D<25 nmol/L consumed less margarine but more meat. Conclusion: Vitamin D deficiency was common in the immigrant patients and their intake of vitamin D was lower. This highlights the need to target information about vitamin D to immigrant women in order to decrease the risk for vitamin D deficiency. The FFQ was well adapted to its purpose to estimate intake of vitamin D.

Nyckelord
immigrants, vitamin D deficiency, primary health care, food, nutrition requirements
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-203368 (URN)10.3402/fnr.v57i0.20089 (DOI)000319261600001 ()
Tillgänglig från: 2013-07-09 Skapad: 2013-07-09 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
2. Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women
Öppna denna publikation i ny flik eller fönster >>Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women
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2013 (Engelska)Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 14, 129- s.Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background

Determinants of vitamin D status measured as 25-OH-vitamin D in blood are exposure to sunlight and intake of vitamin D through food and supplements. It is unclear how large the contributions are from these determinants in Swedish primary care patients, considering the low radiation of UVB in Sweden and the fortification of some foods. Asian and African immigrants in Norway and Denmark have been found to have very low levels, but it is not clear whether the same applies to Swedish patients. The purpose of our study was to identify contributors to vitamin D status in Swedish women attending a primary health care centre at latitude 60°N in Sweden.

Methods

In this cross-sectional, observational study, 61 female patients were consecutively recruited between January and March 2009, irrespective of reason for attending the clinic. The women were interviewed about their sun habits, smoking, education and food intake at a personal appointment and blood samples were drawn for measurements of vitamin D and calcium concentrations.

Results

Plasma concentration of 25-OH-vitamin D below 25 nmol/L was found in 61% (19/31) of immigrant and 7% (2/30) of native women. Multivariate analysis showed that reported sun holiday of one week during the last year at latitude below 40°N with the purpose of sun-bathing and native origin, were significantly, independently and positively associated with 25-OH-vitamin D concentrations in plasma with the strongest association for sun holiday during the past year.

Conclusions

Vitamin D deficiency was common among the women in the present study, with sun holiday and origin as main determinants of 25-OH-vitamin D concentrations in plasma. Given a negative effect on health this would imply needs for vitamin D treatment particularly in women with immigrant background who have moved from lower to higher latitudes.

Keywords: Vitamin D; Sun habits; Immigrant; Women; Primary health care

Nationell ämneskategori
Allmän medicin
Identifikatorer
urn:nbn:se:uu:diva-208596 (URN)10.1186/1471-2296-14-129 (DOI)000324297400001 ()
Tillgänglig från: 2013-10-04 Skapad: 2013-10-04 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
3. Polymorphisms in the CYP2R1 gene are associated with 25OHD3 and bone mineral density, but not with calcium and phosphate concentrations (MrOS Sweden).
Öppna denna publikation i ny flik eller fönster >>Polymorphisms in the CYP2R1 gene are associated with 25OHD3 and bone mineral density, but not with calcium and phosphate concentrations (MrOS Sweden).
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Klinisk medicin
Forskningsämne
Endokrinologi och Diabetologi
Identifikatorer
urn:nbn:se:uu:diva-317312 (URN)
Tillgänglig från: 2017-03-13 Skapad: 2017-03-13 Senast uppdaterad: 2017-03-13
4. Genetic variation in the vitamin D receptor gene is not associated with measures of muscle strength, physical performance, or falls in elderly men. Data from MrOS Sweden.
Öppna denna publikation i ny flik eller fönster >>Genetic variation in the vitamin D receptor gene is not associated with measures of muscle strength, physical performance, or falls in elderly men. Data from MrOS Sweden.
Visa övriga...
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:uu:diva-315701 (URN)
Tillgänglig från: 2017-02-19 Skapad: 2017-02-19 Senast uppdaterad: 2017-03-30

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