Recommended summer sunlight exposure amounts fail to produce sufficient vitamin D status in UK adults of South Asian origin

Farrar, Mark D.; Kift, Richard; Felton, Sarah; Berry, Jacqueline; Durkin, Mike; Allan, Donald; Vail, Andy; Webb, Ann R.; Rhodes, Lesley E.

doi:10.3945/ajcn.111.019976

Cited by 109 publications

(114 citation statements)

References 33 publications

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“…However, exposure can be affected by environmental factors such as latitude, altitude, season, time of day, cloud cover, and air quality [123][124][125][126][127][128][129] as well as personal factors such as occupation, lifestyle, culture such as clothing, and preference which may modify the time spent outdoors and/or the surface area of skin exposed to sunlight [130][131][132][133] . Finally, the dose response of circulating 25OHD to cutaneous UVB exposure is dependent on skin pigmentation, age, body composition, genetic factors, and baseline 25OHD levels, among others [121,131,[134][135][136][137][138] .…”

Section: Evidencementioning

confidence: 99%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

359

477

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Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. nology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. Key WordsRickets · Nutrition · Vitamin D · Calcium · Consensus recommendations Abstract Background: Vitamin D and ca...

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Section: Evidencementioning

confidence: 99%

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Munns¹,

Shaw²,

Kiely³

et al. 2016

Horm Res Paediatr

359

477

View full text Add to dashboard Cite

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“…The duration and extent of poor vitamin D status is probably dependent on how efficiently vitamin D stores of the body are filled during the summer months. This again is determined by latitude, skin pigmentation, lifestyle and clothing habits, and therefore is highly variable [60]. Additionally, a high consumption of meat can contribute to vitamin D status due to its 25-OHD content.…”

Section: How Can the Long-term Vitamin D Status Be Assessed?mentioning

confidence: 99%

Challenges in describing vitamin D status and activity / Herausforderungen bei der Bestimmung des Vitamin D-Status

Vogeser

Bacher

Seger³

2013

Laboratoriumsmedizin

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Within a few years, 25-hydroxyvitamin D (25-OHD) 1 has emerged as a high volume test in many regions. Several analytical issues have been recognized regarding this analyte, in particular variable co-detection of metabolites (25-hydroxyvitamin D 2 ; 3-epi-25-hydroxyvitamin D; 24,25-dihydroxyvitamin D), variable release of the analyte from its protein bonds and matrix effects in automated ligand binding tests, contributing to an often unsatisfactory correlation of high-throughput assays with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Reference methods based on LC-MS/MS as well as reference materials have been introduced only very recently, achieving a truly significant improvement in the standardization of serum 25-OHD measurement. However, beyond these analytical issues in relation to 25-OHD, it should be scrutinized how biologically appropriate this inactive intermediate metabolite can actually describe vitamin D status as a surrogate marker -individually and at a population level. There is, for example, at present little knowledge regarding individual vitamin D requirement in relation to dietary calcium supply; the impact of genetic variation of vitamin D binding protein on serum concentrations; the impact of genetic variation in downstream metabolism and signaling of vitamin D on individual vitamin demand. Furthermore, there is no accepted approach to assess functional whole year vitamin D status, addressing the fundamental seasonal variation of endogenous generation of vitamin D in many regions. Consequently, additional functional markers should be considered when describing vitamin D status (parathyroid hormone, corrected serum calcium and phosphate, urinary calcium, well selected bone markers, etc.), with season-adapted sampling strategies. In conclusion, it should be recognized that there is substantial uncertainty in the currently used approach to characterize vitamin D status by singular measurement of 25-OHD using mainstream assays. It seems questionable to focus the worldwide debate on a widespread vitamin supplementation merely on cut-off results of this marker. Zusammenfassung: Innerhalb weniger Jahre hat sich 25-Hydroxy-Vitamin D (25-OHD) in vielen Regionen zu einer massenhaft angeforderten Messgröße entwickelt. Eine Reihe von analytischen Problemen wurden bezüglich dieses Analyten erkannt, insbesondere eine variable Miterfassung von Metaboliten (25-Hydoxyvitamin D 2 , 3-epi-25-Hydroxyvitamin D 3 , 24,25-Dihydroxy-Vitamin D), die variable Ablösung des Analyten aus seiner Proteinbindung und Matrixeffekte bei Ligandenbindungs-Tests. All dies trägt zu einer oft unbefriedigenden Korrelation von Hochdurchsatz-Methoden mit der LC-MS/MS bei. Referenzmethoden auf Basis der LC-MS/MS sowie Referenzmaterialien wurden erst vor relativ kurzer Zeit eingeführt; in der Tat hat dies zu einer wesentlichen Verbesserung der Standardisierung der 25-OHD-Messung beigetragen. Über diese analytischen Probleme bezüglich 25-OHD hinaus sollte jedoch eingehend hinterfragt werden, wie biologisch valide dieser inak...

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“…Use of sunscreen at recommended levels (2 mg/cm 2 ) decreases the effectiveness of vitamin D production [44], but epidemiological studies suggest that frequent sunscreen users do not have lower levels of 25(OH)D than Review Wyatt, Neale & Lucas future science group infrequent users after taking account of the time spent outdoors [45][46][47]. The moderating effect of skin pigmentation (melanin density) is controversial, although most experimental studies using lamps with an output that is realistic for sun exposure at Earth's surface show that darker skin decreases the amount of vitamin D produced for any dose of UV-B radiation [40,42,[48][49][50][51][52][53].…”

Section: An Introduction To Vitamin Dmentioning

confidence: 95%

Skin Cancer and Vitamin D: An Update

Wyatt

Lucas

2015

Melanoma Manag.

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Exposure of the skin to solar ultraviolet (UV) radiation has both risks and benefits for human health. Absorption of UV-B radiation by DNA results in mutations that underlie the development of skin cancers, as is apparent from genetic studies showing high occurrence of UV signature mutations within these tumors. UV-B radiation is also absorbed by 7-dehydrocholesterol to initiate vitamin D synthesis. In experimental studies vitamin D metabolites enhance apoptosis of malignant cells, inhibit angiogenesis and proliferation and increase differentiation, potentially reducing skin cancer development and improving prognosis after diagnosis. There are some supporting human data. We review the links between sun exposure, vitamin D and skin cancers.

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Recommended summer sunlight exposure amounts fail to produce sufficient vitamin D status in UK adults of South Asian origin

Abstract: Sunlight-exposure recommendations are inappropriate for individuals of South Asian ethnicity who live at the UK latitude. More guidance is required to meet the vitamin D requirements of this sector of the population. This study was registered at www.isrctn.org as ISRCTN 07565297.

Cited by 109 publications

References 33 publications

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

Challenges in describing vitamin D status and activity / Herausforderungen bei der Bestimmung des Vitamin D-Status

Skin Cancer and Vitamin D: An Update

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