The Winding Path Towards an Inverse Relationship Between Sun Exposure and All-cause Mortality

Lindqvist, Pelle G.

doi:10.21873/anticanres.12337

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…UVA radiation photo-releases nitric oxide (NO) from stores in the skin whence it is mobilised to the systemic circulation, causing vasodilation and reduction in blood pressure 5 , offering cardiovascular and metabolic benefits from UV exposure 5 8 . As cardio-metabolic disease and possibly hypertension 22 increase the risk of death from COVID-19, any UV driven improvements in these risk factors would be expected to reduce mortality 23 . Nitric oxide may also have a specific effect on COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Ultraviolet A Radiation and COVID-19 Deaths in the USA with replication studies in England and Italy

Cherrie

Clemens

Colandrea

et al. 2020

Preprint

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Objectives To determine whether UVA exposure might be associated with COVID-19 deaths Design Ecological model and meta-analysis Setting 2,474 counties of the contiguous USA, 6,755 municipalities in Italy, 6,274 areas in England. Data were collected during their Vitamin D winter (monthly mean UVvitd of under 165 KJ/m2) from Jan to April 2020. Participants The at-risk population is the total county population, with measures to incorporate spatial infection into the model. The model is adjusted for: age, ethnicity, socioeconomic deprivation, long term PM2.5, and UV weighted by the vitamin D action spectrum. Main outcome measures We derive UVA measures for each area and estimate their relationship with COVID-19 mortality with a random effect for States, in a multilevel zero-inflated negative binomial model. In the USA and England death certificates had to record COVID-19. In Italy excess deaths in 2020 over expected from 2015-19. Data sources Satellite derived mean daily UVA dataset from Japan Aerospace Exploration Agency. Data on deaths compiled by Center for Disease Control (USA), Office for National Statistics (England) and Italian Institute of Statistics. Results Daily mean UVA (January-April 2020) varied between 450 to 1,000 KJ/m2 across the three countries. Our fully adjusted model showed an inverse correlation between UVA and COVID-19 mortality with a Mortality Risk Ratio (MRR) of 0.73 (0.62 to 0.87)per 100KJ/m2 increase UVA in the USA, 0.81 (0.71 to 0.93) in Italy and 0.51 (0.39 to 0.66) in England. Pooled MRR was 0.68 (0.53 to 0.66). Conclusions Our analysis, replicated in 3 independent national datasets, suggests ambient UVA exposure is associated with lower COVID-19 specific mortality. This effect is independent of vitamin D, as it occurred at irradiances below that likely to induce significant cutaneous vitamin D3 synthesis. Causal interpretations must be made cautiously in observational studies. Nonetheless this study suggests strategies for reduction of COVID-19 mortality

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Section: Discussionmentioning

confidence: 99%

Ultraviolet A Radiation and COVID-19 Deaths in the USA with replication studies in England and Italy

Cherrie

Clemens

Colandrea

et al. 2020

Preprint

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“…Metabolic dysfunction such as overweight, high low-density lipoprotein cholesterol level, and abnormal insulin levels is reduced in mice irradiated with UV light (56). Inverse relationship is observed between sun exposure and all-cause mortality (9,57). Circadian clocks regulating behavior, physiology, and metabolism can be disrupted by insufficient sun exposure (58).…”

Section: Discussionmentioning

confidence: 99%

“…Abundant studies have illustrated the intake of Vit D gaining the upper hand, in the consideration of the carcinogenic property of excessive UV radiation, uncertain individual responsiveness, and the inaccessibility for countries at high latitudes ( 7 , 8 ). Nevertheless, emerging studies are discussing the incomparable advantages of obtaining Vit D from sun exposure, which include the reduction in all-cause mortality ( 9 , 10 ), cardiovascular benefits ( 11 ), and potential lower COVID-19-specific mortality ( 12 ). The call for transforming the concept of absolute sun avoidance to acceptance of non-burning sun exposure is grasping attention ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Moderate Sun Exposure Is the Complementor in Insufficient Vitamin D Consumers

Chen

2022

Front. Nutr.

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Background and AimsVitamin (Vit) D plays a vital role in human health, and the prevalence of Vit D deficiency worldwide has been a rising concern. This study investigates the serum 25-hydroxy-Vit D [25(OH)D] status in healthy US civilians and identifies how the two main sources, sun exposure and dietary Vit D intake, determine the final 25(OH)D levels in individuals.MethodsA total of 2,360 of participants from The National Health and Nutrition Examination Survey (NHANES) 2009–2014 were analyzed. We divided the levels of sun exposure and dietary Vit D intake of all subjects into 10 strata and gave a score ranging from 1 to 10 points, respectively. Scores 1–5 in sun exposure and dietary intake were considered as relatively low exposure groups, whereas scores 6–10 were considered as relatively high exposure groups. Serum Vit D inadequacy was defined as <50 nmol/L. Linear and logistic regression analyses were used to examine the associations between sources of Vit D and serum 25(OH)D levels.ResultsIn relatively low Vit D intake groups (Vit D intake score 1–5), relatively high sun exposure (sun exposure score >5) resulted in higher serum 25(OH)D levels (average 57 nmol/L) compared with relatively low sun exposure (sun exposure score <5) (average 50 nmol/L), whereas this difference became negligible in high intake groups (Vit D intake score 6–10). Moreover, the greatest slope occurred in the low Vit D intake curve (decile 3 of Vit D intake), which shows increased sun exposure time causing the greatest degree of change in serum 25(OH)D level in this group.ConclusionSun exposure can significantly make up for deficiencies in subjects who consume insufficient dietary Vit D. Compared with the extra cost and time for building habits of Vit D supplementation, moderate sun exposure appears to be a simple and costless means for the public to start in daily practice.

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“…At higher latitudes with less regional UV radiation, fair UVsensitive skin is more common [3]. The fairer the skin, the shorter sun exposure is necessary for vitamin D production and other health effects [1,4]. Evolution normally acts according to the principle of survival of the fittest.…”

Section: Introductionmentioning

confidence: 99%

Women with fair phenotypes seem to confer a survival advantage in a low UV milieu. A nested matched case control study

et al. 2020

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Background Sun exposure in combination with skin pigmentation is the main determinant for vitamin D status. Human skin color seems to be adapted and optimized for regional sun ultraviolet (UV) intensity. However, we do not know if fair, UV-sensitive skin is a survival advantage in regions with low UV radiation. Methods A population-based nested case-control study of 29,518 Caucasian women, ages 25 to 64 years from Southern Sweden who responded to a questionnaire regarding risk-factors for malignant melanoma in 1990 and followed for 25 years. For each fair woman, defined as having red hair or freckles (n = 11,993), a control was randomly selected from all non-fair women from within the cohort of similar age, smoking habits, education, marital status, income, and comorbidity, i.e., 11,993 pairs. The main outcome was the difference in allcause mortality between fair and non-fair women in a low UV milieu, defined as living in Sweden and having low-to-moderate sun exposure habits. Secondary outcomes were mortality by sun exposure, and among those non-overweight. Results In a low UV milieu, fair women were at a significantly lower all-cause mortality risk as compared to non-fair women (log rank test p = 0.04) with an 8% lower all-cause mortality rate (hazard ratio [HR] = 0.92, 95% CI 0.84-1.0), including a 59% greater risk of dying from skin cancer among fair women (HR 1.59, 95% CI 1.26-2.0). Thus, it seem that the beneficial health effect from low skin coloration outweigh the risk of skin cancer at high latitudes.

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The Winding Path Towards an Inverse Relationship Between Sun Exposure and All-cause Mortality

Cited by 9 publications

References 21 publications

Ultraviolet A Radiation and COVID-19 Deaths in the USA with replication studies in England and Italy

Ultraviolet A Radiation and COVID-19 Deaths in the USA with replication studies in England and Italy

Moderate Sun Exposure Is the Complementor in Insufficient Vitamin D Consumers

Women with fair phenotypes seem to confer a survival advantage in a low UV milieu. A nested matched case control study

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