Sun protective behaviors and vitamin D levels in the US population: NHANES 2003–2006

Abstract

Background Sun protection is recommended for skin cancer prevention, yet little is known about the role of sun protection on vitamin D levels. Our aim was to investigate the relationship between different types of sun protective behaviors and serum 25(OH)D levels in the general US population. Methods Cross-sectional, nationally representative survey of 5,920 adults aged 18–60 years in the US National Health and Nutrition Examination Survey 2003–2006. We analyzed questionnaire responses on sun protective behaviors: staying in the shade, wearing long sleeves, wearing a hat, using sunscreen and SPF level. Analyses were adjusted for multiple confounders of 25(OH)D levels and stratified by race. Our primary outcome measures were serum 25(OH)D levels (ng/ml) measured by radioimmunoassay and vitamin D deficiency, defined as 25(OH)D levels <20 ng/ml. Results Staying in the shade and wearing long sleeves were significantly associated with lower 25(OH)D levels. Subjects who reported frequent use of shade on a sunny day had −3.5 ng/ml (ptrend < 0.001) lower 25(OH)D levels compared to subjects who reported rare use. Subjects who reported frequent use of long sleeves had −2.2 ng/ml (ptrend = 0.001) lower 25(OH)D levels. These associations were strongest for whites, and did not reach statistical significance among Hispanics or blacks. White participants who reported frequently staying in the shade or wearing long sleeves had double the odds of vitamin D deficiency compared with those who rarely did so. Neither wearing a hat nor using sunscreen was associated with low 25(OH)D levels or vitamin D deficiency. Conclusions White individuals who protect themselves from the sun by seeking shade or wearing long sleeves may have lower 25(OH)D levels and be at risk for vitamin D deficiency. Frequent sunscreen use does not appear to be linked to vitamin D deficiency in this population.

High levels of vitamin D associated with less ischemic heart disease – a nested case-control study among rural men in Sweden

“…A plausible explanation for this, despite farmers' high degree of outdoor work, might be that farmers have a more sun-protective behaviour. In a nationally representative sample of almost 6,000 adult US inhabitants, sun protective behaviours, such as staying in the shade and wearing long sleeve clothing, were associated with lower vitamin D levels [39]. This type of sun avoidance in everyday life is typical of Swedish traditional family farmers included in the cohort (personal knowledge).…”

Low 25(OH) vitamin D concentrations in international UK track and field athletes

“…44 In South Africa, the Mediterranean and other sun-rich areas the relevance of this study may not be immediately apparent. While individuals in sun-rich areas may be at less risk, 45 a number of studies have shown a significant prevalence of vitamin D deficiency in these areas, 46,47 potentially due to an individual's skin colour or sunscreen application. Our study findings would support the assertion that clinicians in any geographical area with a significant population of dark-skinned individuals should be mindful of the possibility of vitamin D deficiency.…”

Non-melanoma Skin Cancer in Canada Chapter 2: Primary Prevention of Non-melanoma Skin Cancer

“…Unfortunately, only 56% of Caucasian North Americans report moderate or frequent use of sunscreen when outside on a sunny day. 9 Routine use of sunscreen significantly reduces the incidence of SCC and actinic keratoses (AKs), a class of premalignant lesions that are common precursors of SCCs. [10][11][12] Some of the clearest data on the benefits of UV protection can be found in studies of organ transplant recipients (OTRs), who experience long-term immunosuppression and are particularly susceptible to NMSCs, which can be highly aggressive in these patients.…”