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01-12-2020 | Vitamin D Deficiency | Review

Prediction models and questionnaires developed to predict vitamin D status in adults: a systematic review

Authors: G. Naureen, K. M. Sanders, L. Busija, D. Scott, K. Lim, J. Talevski, C. Connaughton, S. L. Brennan-Olsen

Published in: Osteoporosis International | Issue 12/2020

Abstract

A systematic review of prediction models/questionnaires developed to identify people with deficient/insufficient vitamin D status shows the potential of self-reported information to estimate vitamin D status. The objective is to identify and compare existing screening tools, developed to identify vitamin D deficiency or insufficiency in adults. A systematic search of literature was conducted using MEDLINE, Scopus, Web of Science and CINAHL databases. Risk of bias and applicability concerns were assessed by quality assessment of diagnostic accuracy studies (QUADAS-2). Data were extracted on socio-demographic, anthropometric, risk factors, serum 25 hydroxyvitamin D [25(OH)D] levels, statistical methods and predictive ability. A total of 12 studies were considered for inclusion for this systematic review after screening of 4851 abstracts and 15 full-text articles. Ten of twelve studies developed prediction models and 2 studies developed questionnaires. The majority of studies had low risk of bias and applicability as assessed by QUADAS-2. All studies included only self-reported predictors of vitamin D status in their final models and development of scores. Sunlight exposure and related factors were important significant contributors to the predictive ability of the models and/or questionnaires. Sensitivity and specificity of the prediction models or questionnaires ranged from 55 to 91% and 35 to 84%, respectively. Six out of twelve studies converted final models to scores associated with vitamin D status. There was no evidence that any of these existing tools have been translated into clinical practice. The prediction models or questionnaires identified in this systematic review were moderately sensitive and specific for identifying people with vitamin D deficiency or insufficiency. The substantial contribution of sunlight exposure to the prediction of vitamin D status highlights the importance of including this information when developing vitamin D screening tools.

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Umar M, Sastry KS, Chouchane AI (2018) Role of vitamin D beyond the skeletal function: a review of the molecular and clinical studies. IJMS 19(6):1618. https://doi.org/10.3390/ijms19061618CrossRef

McCollum EV, Simmonds N, Becker JE, Shipley PG (1922) Studies on experimental rickets. XXI An experimental demonstration of the existence of a vitamin which promotes calcium deposition. J Biol Chem 53(19):293–312

Wilson LR, Tripkovic L, Hart KH, Lanham-New SA (2017) Vitamin D deficiency as a public health issue: using vitamin D2 or vitamin D3 in future fortification strategies. Proc Nutr Soc 76(3):392–399. https://doi.org/10.1017/s0029665117000349CrossRefPubMed

Holick M (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281. https://doi.org/10.1056/NEJMra070553CrossRefPubMed

Khan AH, Iqbal R (2009) Vitamin D deficiency in an ample sunlight country. JCPSP 5:267–268

Isaia G, Giorgino R, Rini GB, Bevilacqua M, Maugeri D, Adami S (2003) Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors. Osteoporos Int 14(7):577–582. https://doi.org/10.1007/s00198-003-1390-7CrossRefPubMed

Palacios C, Gonzalez L (2014) Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol 144PA:138–145. https://doi.org/10.1016/j.jsbmb.2013.11.003CrossRef

Calvo MS, Whiting SJ (2013) Survey of current vitamin D food fortification practices in the United States and Canada. J Steroid Biochem Mol Biol 136:211–213. https://doi.org/10.1016/j.jsbmb.2012.09.034CrossRefPubMed

Bilinski KL, Boyages SC (2012) The rising cost of vitamin D testing in Australia: time to establish guidelines for testing. In: Med J Aust, vol 197. Vol 2. Australia, p 90

10.

Department of Health Australian Government (2014) Vitamin D testing review report

11.

French National Authority for Health (2014) Clinical utility of the measurement of vitamin D. https://www.has-sante.fr/portail/upload/docs/application/pdf/2014-03/clinical_utility_of_the_measurement_of_vitamin_d_-_brief_inahta.pdf. Accessed 09/01/2020

12.

Sattar N, Welsh P, Panarelli M, Forouhi NG (2012) Increasing requests for vitamin D measurement: costly, confusing, and without credibility. Lancet 379(9811):95–96. https://doi.org/10.1016/s0140-6736(11)61816-3CrossRefPubMed

13.

Szabo L (2018) Vitamin D, the sunshine supplement, has shadowy money behind it. . https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.html. Accessed 19/03/2020

14.

Medical Advisory Secretariat (2010) Clinical utility of vitamin d testing: an evidence-based analysis. Ont Health Technol Assess Ser, vol 10. Medical Advisory Secretariat,

15.

Faulkner A, Reidy M, McGowan J (2017) Should we abandon routine blood tests? BMJ (clinical research ed) 357. https://doi.org/10.1136/bmj.j2091

16.

My Health Alberta (2018) Guidelines for vitamin D testing. https://myhealth.alberta.ca/Alberta/Pages/Vitamin-d-testing-in-Alberta.aspx. Accessed 11/06/2019

17.

Bilinski K, Boyages S (2013) Evidence of overtesting for vitamin D in Australia: an analysis of 4.5 years of Medicare Benefits Schedule (MBS) data. BMJ Open 3(6). https://doi.org/10.1136/bmjopen-2013-002955

18.

Souberbielle JC, Benhamou CL, Cortet B, Rousiere M, Roux C, Abitbol V, Annweiler C, Audran M, Bacchetta J, Bataille P, Beauchet O, Bardet R, Benachi A, Berenbaum F, Blain H, Borson-Chazot F, Breuil V, Briot K, Brunet P, Carel JC, Caron P, Chabre O, Chanson P, Chapurlat R, Cochat P, Coutant R, Christin-Maitre S, Cohen-Solal M, Combe C, Cormier C, Courbebaisse M, Debrus G, Delemer B, Deschenes G, Duquenne M, Duval G, Fardellone P, Fouque D, Friedlander G, Gauvain JB, Groussin L, Guggenbuhl P, Houillier P, Hannedouche T, Jacot W, Javier RM, Jean G, Jeandel C, Joly D, Kamenicky P, Knebelmann B, Lafage-Proust MH, LeBouc Y, Legrand E, Levy-Weil F, Linglart A, Machet L, Maheu E, Mallet E, Marcelli C, Mares P, Mariat C, Maruani G, Maugars Y, Montagnon F, Moulin B, Orcel P, Partouche H, Personne V, Pierrot-Deseilligny C, Polak M, Pouteil-Noble C, Prie D, Raynaud-Simon A, Rolland Y, Sadoul JL, Salle B, Sault C, Schott AM, Sermet-Gaudelus I, Soubrier M, Tack I, Thervet E, Tostivint I, Touraine P, Tremollieres F, Urena-Torres P, Viard JP, Wemeau JL, Weryha G, Winer N, Young J, Thomas T (2016) French law: what about a reasoned reimbursement of serum vitamin D assays? Geriatrie et Psychologie Neuropsychiatrie du Vieillissement 14(4):377–382. https://doi.org/10.1684/pnv.2016.0631CrossRefPubMed

19.

Fonseca V, Tongia R, el-Hazmi M, Abu-Aisha H (1984) Exposure to sunlight and vitamin D deficiency in Saudi Arabian women. Postgrad Med J 60(707):589–591CrossRef

20.

Khan AH, Iqbal R, Naureen G, Dar FJ, Ahmed FN (2012) Prevalence of vitamin D deficiency and its correlates: results of a community-based study conducted in Karachi, Pakistan. Arch Osteoporos 7(1–2):275–282. https://doi.org/10.1007/s11657-012-0108-xCrossRefPubMed

21.

Gill TK, Hill CL, Shanahan EM, Taylor AW, Appleton SL, Grant JF, Shi Z, Grande ED, Price K, Adams RJ (2014) Vitamin D levels in an Australian population. BMC Public Health 14(1):1001. https://doi.org/10.1186/1471-2458-14-1001CrossRefPubMedPubMedCentral

22.

Voortman T, van den Hooven EH, Heijboer AC, Hofman A, Jaddoe VW, Franco OH (2015) Vitamin D deficiency in school-age children is associated with sociodemographic and lifestyle factors. J Nutr 145(4):791–798. https://doi.org/10.3945/jn.114.208280CrossRefPubMed

23.

Daly RM, Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Sikaris KA, Zimmet PZ, Ebeling PR, Shaw JE (2012) Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clin Endocrinol 77(1):26–35. https://doi.org/10.1111/j.1365-2265.2011.04320.xCrossRef

24.

McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: the PRISMA-DTA Statement. JAMA 319(4):388–396. https://doi.org/10.1001/jama.2017.19163CrossRefPubMed

25.

Holick MF (2009) Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 19(2):73–78. https://doi.org/10.1016/j.annepidem.2007.12.001CrossRefPubMed

26.

Atef SH (2018) Vitamin D assays in clinical laboratory: past, present and future challenges. J Steroid Biochem Mol Biol 175:136–137. https://doi.org/10.1016/j.jsbmb.2017.02.011CrossRefPubMed

27.

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009CrossRefPubMed

28.

Annweiler C, Kabeshova A, Legeay M, Fantino B, Beauchet O (2015) Derivation and validation of a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D. J Am Med Dir Assoc 16(6):536.e538–536.e519CrossRef

29.

Bertrand KA, Edward G, Liu Y, Malspeis S, Eliassen AH, Wu K, Holmes MD, Laden F, Feskanich D (2012) Determinants of plasma 25-hydroxyvitamin D and development of prediction models in three US cohorts. Br J Nutr 108(10):1889–1896CrossRef

30.

Bolek-Berquist J, Elliott ME, Gangnon RE, Gemar D, Engelke J, Lawrence SJ, Hansen KE (2009) Use of a questionnaire to assess vitamin D status in young adults. Public Health Nutr 12(2):236–243. https://doi.org/10.1017/S136898000800356XCrossRefPubMed

31.

Deschasaux M, Souberbielle JC, Andreeva VA, Sutton A, Charnaux N, Kesse-Guyot E, Latino-Martel P, Druesne-Pecollo N, Szabo de Edelenyi F, Galan P, Hercberg S, Ezzedine K, Touvier M (2016) Quick and easy screening for vitamin D insufficiency in adults: a scoring system to be implemented in daily clinical practice. Medicine 95(7):e2783. https://doi.org/10.1097/MD.0000000000002783CrossRefPubMedPubMedCentral

32.

Kuwabara A, Tsugawa N, Mizuno K, Ogasawara H, Watanabe Y, Tanaka K (2019) A simple questionnaire for the prediction of vitamin D deficiency in Japanese adults (vitamin D deficiency questionnaire for Japanese: VDDQ-J). J Bone Miner Metab 37(5):854–863. https://doi.org/10.1007/s00774-018-0984-2CrossRefPubMed

33.

Lee A, Samy W, Chiu CH, Chan SK, Gin T, Chui PT (2016) Determinants of serum 25-hdroxyvitamin D cncentrations and a sreening test for moderate-to-severe hypovitaminosis D in chinese patients undergoing total joint arthroplasty. JOA 31(9):1921–1926

34.

Lopes JB, Fernandes GH, Takayama L, Figueiredo CP, Pereira RMR (2014) A predictive model of vitamin D insufficiency in older community people: from the Sao Paulo Aging & Health Study (SPAH). Maturitas 78(4):335–340CrossRef

35.

Lukaszuk JM, Prawitz AD, Johnson KN, Umoren J, Bugno TJ (2012) Development of a noninvasive vitamin D screening tool. FCSRJ 40(3):229–240. https://doi.org/10.1111/j.1552-3934.2011.02107.xCrossRef

36.

Merlijn T, Swart KMA, Lips P, Heymans MW, Sohl E, Van Schoor NM, Netelenbos CJ, Elders PJM (2018) Prediction of insufficient serum vitamin D status in older women: a validated model. Osteoporos Int 29(7):1539–1547. https://doi.org/10.1007/s00198-018-4410-3CrossRefPubMedPubMedCentral

37.

Sohl E, Heymans MW, de Jongh RT, den Heijer M, Visser M, Merlijn T, Lips P, van Schoor NM (2014) Prediction of vitamin D deficiency by simple patient characteristics. Am J Clin Nutr 99(5):1089–1095CrossRef

38.

Tran B, Armstrong BK, McGeechan K, Ebeling PR, English DR, Kimlin MG, Lucas R, van der Pols JC, Venn A, Gebski V, Whiteman DC, Webb PM, Neale RE (2013) Predicting vitamin D deficiency in older Australian adults. Clin Endocrinol 79(5):631–640. https://doi.org/10.1111/cen.12203CrossRef

39.

Vignali E, Macchia E, Cetani F, Reggiardo G, Cianferotti L, Saponaro F, Marcocci C (2017) Development of an algorithm to predict serum vitamin D levels using a simple questionnaire based on sunlight exposure. Endocrine 55(1):85–92CrossRef

40.

Formiga F, Ferrer A, Almeda J, San Jose A, Gil A, Pujol R (2011) Utility of geriatric assessment tools to identify 85-years old subjects with vitamin D deficiency. J Nutr Health Aging 15(2):110–114CrossRef

41.

Lee MJ, Hsu HJ, Wu IW, Sun C, Ting MK, Lee CC (2019) Vitamin D deficiency in northern Taiwan: a community-based cohort study. BMC Public Health 19(1):337. https://doi.org/10.1186/s12889-019-6657-9CrossRefPubMedPubMedCentral

42.

Liu X, Baylin A, Levy PD (2018) Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications. Br J Nutr 119(8):928–936. https://doi.org/10.1017/S0007114518000491CrossRefPubMed

43.

van der Meer IM, Middelkoop BJC, Boeke AJP, Lips P (2011) Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview. Osteoporos Int 22(4):1009–1021. https://doi.org/10.1007/s00198-010-1279-1CrossRefPubMed

44.

Harris SS (2006) Vitamin D and African Americans. J Nutr 136(4):1126–1129. https://doi.org/10.1093/jn/136.4.1126CrossRefPubMed

45.

Fraser DR (2004) Vitamin D-deficiency in Asia. J Steroid Biochem Mol Biol 89-90:491–495. https://doi.org/10.1016/j.jsbmb.2004.03.057CrossRefPubMed

46.

Mat S, Jaafar MH, Sockalingam S, Raja J, Kamaruzzaman SB, Chin AV, Abbas AA, Chan CK, Hairi NN, Othman S, Cumming R, Tan MP (2018) Vitamin D deficiency is associated with ethnicity and knee pain in a multi-ethnic South-East Asian nation: results from Malaysian Elders Longitudinal Research (MELoR). Int J Rheum Dis 21(5):930–936. https://doi.org/10.1111/1756-185x.13279CrossRefPubMed

47.

Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J (2009) Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 20(11):1807–1820. https://doi.org/10.1007/s00198-009-0954-6CrossRefPubMed

48.

Dar FJ, Iqbal R, Ghani F, Siddiqui I, Khan AH (2012) Bone health status of premenopausal healthy adult females in Pakistani females. Arch Osteoporos 7(1–2):93–99. https://doi.org/10.1007/s11657-012-0085-0CrossRefPubMed

49.

Aparna P, Muthathal S, Nongkynrih B, Gupta SK (2018) Vitamin D deficiency in India. J Family Med Prim Care 7(2):324–330. https://doi.org/10.4103/jfmpc.jfmpc_78_18CrossRefPubMedPubMedCentral

50.

Akhtar S (2016) Vitamin D status in south asian populations - risks and opportunities. Crit Rev Food Sci Nutr 56(11):1925–1940. https://doi.org/10.1080/10408398.2013.807419CrossRefPubMed

51.

Lips P, de Jongh RT (2018) Vitamin D deficiency in immigrants. Bone Rep 9:37–41. https://doi.org/10.1016/j.bonr.2018.06.001CrossRefPubMedPubMedCentral

52.

Brock K, Huang WY, Fraser DR, Ke L, Tseng M, Stolzenberg-Solomon R, Peters U, Ahn J, Purdue M, Mason RS, McCarty C, Ziegler RG, Graubard B (2010) Low vitamin D status is associated with physical inactivity, obesity and low vitamin D intake in a large US sample of healthy middle-aged men and women. J Steroid Biochem Mol Biol 121(1–2):462–466. https://doi.org/10.1016/j.jsbmb.2010.03.091CrossRefPubMedPubMedCentral

53.

Malacova E, Cheang PR, Dunlop E, Sherriff JL, Lucas RM, Daly RM, Nowson CA, Black LJ (2019) Prevalence and predictors of vitamin D deficiency in a nationally representative sample of adults participating in the 2011-2013 Australian health survey. Br J Nutr 121(8):894–904. https://doi.org/10.1017/s0007114519000151CrossRefPubMed

54.

Ng SW, Popkin BM (2012) Time use and physical activity: a shift away from movement across the globe. Obes Rev 13(8):659–680. https://doi.org/10.1111/j.1467-789X.2011.00982.xCrossRefPubMedPubMedCentral

55.

Nowson CA, McGrath JJ, Ebeling PR, Haikerwal A, Daly RM, Sanders KM, Seibel MJ, Mason RS (2012) Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 196(11):686–687. https://doi.org/10.5694/mja11.10301CrossRefPubMed

56.

Rashedi J, Mahdavi BP, Asgharzadeh M (2016) Extreme religious perceptions and vitamin D. Iran J Public Health 45(8):1102–1102PubMedPubMedCentral

57.

Buyukuslu N, Esin K, Hizli H, Sunal N, Yigit P, Garipagaoglu M (2014) Clothing preference affects vitamin D status of young women. Nutr Res (New York, NY) 34(8):688–693. https://doi.org/10.1016/j.nutres.2014.07.012CrossRef

58.

Tsur A, Metzger M, Dresner-Pollak R (2011) Effect of different dress style on vitamin D level in healthy young orthodox and ultra-orthodox students in Israel. Osteoporos Int 22(11):2895–2898. https://doi.org/10.1007/s00198-010-1492-yCrossRefPubMed

59.

Gannage-Yared MH, Maalouf G, Khalife S, Challita S, Yaghi Y, Ziade N, Chalfoun A, Norquist J, Chandler J (2009) Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women. Br J Nutr 101(4):487–491. https://doi.org/10.1017/s0007114508023404CrossRefPubMed

60.

Kift R, Rhodes LE, Farrar MD, Webb AR (2018) Is sunlight exposure enough to avoid wintertime vitamin D deficiency in United Kingdom population groups? Int J Environ Res Public Health 15(8):1624. https://doi.org/10.3390/ijerph15081624CrossRefPubMedCentral

61.

Wacker M, Holick MF (2013) Sunlight and vitamin D: a global perspective for health. Dermato-Endocrinology 5(1):51–108. https://doi.org/10.4161/derm.24494CrossRefPubMedPubMedCentral

62.

Richard A, Rohrmann S, Quack Lötscher KC (2017) Prevalence of vitamin D deficiency and its associations with skin color in pregnant women in the first trimester in a sample from Switzerland. Nutrients 9(3):260. https://doi.org/10.3390/nu9030260CrossRefPubMedCentral

63.

Zhao LJ, Zhou Y, Bu F, Travers-Gustafson D, Ye A, Xu X, Hamm L, Gorsage DM, Fang X, Deng HW, Recker RR, Lappe JM (2012) Factors predicting vitamin D response variation in non-hispanic white postmenopausal women. J Clin Endocrinol Metab 97(8):2699–2705. https://doi.org/10.1210/jc.2011-3401CrossRefPubMedPubMedCentral

64.

Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, Kim KJ, Rhee Y, Lim SK (2011) Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 96(3):643–651. https://doi.org/10.1210/jc.2010-2133CrossRefPubMed

65.

Gröber U, Kisters K (2012) Influence of drugs on vitamin D and calcium metabolism. Dermato-Endocrinology 4(2):158–166. https://doi.org/10.4161/derm.20731CrossRefPubMedPubMedCentral

66.

Robien K, Oppeneer SJ, Kelly JA, Hamilton-Reeves JM (2013) Drug-vitamin D interactions: a systematic review of the literature. Nutr Clin Pract 28(2):194–208. https://doi.org/10.1177/0884533612467824CrossRefPubMedPubMedCentral

67.

Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC (2010) Benefit-risk assessment of vitamin D supplementation. Osteoporos Int 21(7):1121–1132. https://doi.org/10.1007/s00198-009-1119-3CrossRefPubMed

Title: Prediction models and questionnaires developed to predict vitamin D status in adults: a systematic review
Authors: G. Naureen
K. M. Sanders
L. Busija
D. Scott
K. Lim
J. Talevski
C. Connaughton
S. L. Brennan-Olsen
Publication date: 01-12-2020
Publisher: Springer London
Keyword: Vitamin D Deficiency
Published in: Osteoporosis International / Issue 12/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05539-1

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Prediction models and questionnaires developed to predict vitamin D status in adults: a systematic review

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