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Cancer Causes & Control
Published in: Cancer Causes & Control 1/2012

01-01-2012 | Original paper

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

Authors: Eleni Linos, Elizabeth Keiser, Matthew Kanzler, Kristin L. Sainani, Wayne Lee, Eric Vittinghoff, Mary-Margaret Chren, Jean Y. Tang

Published in: Cancer Causes & Control | Issue 1/2012

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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 (p trend < 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 (p trend = 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.
Appendix
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Literature
1.
2.
3.
4.
Autier P, Gandini S (2007) Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 167:1730–1737PubMedCrossRef
5.
6.
Giovannucci E (2009) Vitamin D and cancer incidence in the Harvard cohorts. Ann Epidemiol 19:84–88PubMedCrossRef
7.
8.
9.
Wolpowitz D, Gilchrest BA (2006) The vitamin D questions: how much do you need and how should you get it? J Am Acad Dermatol 54:301–317PubMedCrossRef
10.
Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A (2006) Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 296:2832–2838PubMedCrossRef
11.
Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB et al (2009) Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 169:551–561PubMedCrossRef
12.
Martins D, Wolf M, Pan D, Zadshir A, Tareen N et al (2007) Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 167:1159–1165PubMedCrossRef
13.
Wang L, Manson JE, Song Y, Sesso HD (2010) Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 152:315–323PubMed
14.
Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637PubMedCrossRef
15.
O’Donnell S, Moher D, Thomas K, Hanley DA, Cranney A (2008) Systematic review of the benefits and harms of calcitriol and alfacalcidol for fractures and falls. J Bone Miner Metab 26:531–542PubMedCrossRef
16.
Cranney A, Weiler HA, O’Donnell S, Puil L (2008) Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr 88:513S–519SPubMed
17.
Avenell A, Gillespie WJ, Gillespie LD, O’Connell D (2009) Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 3:CD000227
18.
Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL et al (2006) Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med 354:684–696PubMedCrossRef
19.
Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J et al (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354:669–683PubMedCrossRef
20.
21.
Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64:1165–1168PubMedCrossRef
22.
Norval M, Wulf HC (2009) Does chronic sunscreen use reduce vitamin D production to insufficient levels? Br J Dermatol 161(4):732–736PubMedCrossRef
23.
24.
Kurd S, Gelfand J (2009) The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: Results from NHANES 2003–2004. J Am Acad Dermatol 60:218–224PubMedCrossRef
25.
Centers for Disease Control and Prevention, National Center for Health Statistics, NHANES (2004) Documentation, codebook, and frequencies. mec exam component: dermatology examination data
26.
27.
Looker AC, Lacher DA, Pfeiffer CM, Schleicher RL, Picciano MF et al (2009) Data advisory with regard to NHANES serum 25-hydroxyvitamin D data. Am J Clin Nutr 90:695PubMedCrossRef
28.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28PubMed
29.
30.
Yetley EA (2008) Assessing the vitamin D status of the US population. Am J Clin Nutr 88:558S–564SPubMed
31.
Looker AC, Pfeiffer CM, Lacher DA, Schleicher RL, Picciano MF et al (2008) Serum 25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–2004. Am J Clin Nutr 88:1519–1527PubMedCrossRef
32.
WA TangJY, Linos E, Parimi N, Lee W, Aszterbaum M, Agari M, Bickers, Epstein E (2010) High prevalence of vitamin d deficiency in patients with basal cell nevus syndrome. Arch Dermatol 146:1105–1110CrossRef
33.
Marks R (1999) Sunlight and health. Use of sunscreens does not risk vitamin D deficiency. BMJ 319:1066; author reply 1068
34.
Marks R, Foley PA, Jolley D, Knight KR, Harrison J et al (1995) The effect of regular sunscreen use on vitamin D levels in an Australian population. Results of a randomized controlled trial. Arch Dermatol 131:415–421PubMedCrossRef
35.
Thieden E, Philipsen PA, Sandby-Moller J, Wulf HC (2005) Sunscreen use related to UV exposure, age, sex, and occupation based on personal dosimeter readings and sun-exposure behavior diaries. Arch Dermatol 141:967–973PubMedCrossRef
36.
Autier P, Boniol M, Dore JF (2007) Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer 121:1–5PubMedCrossRef
37.
Davis KJ, Cokkinides VE, Weinstock MA, O’Connell MC, Wingo PA (2002) Summer sunburn and sun exposure among US youths ages 11 to 18: national prevalence and associated factors. Pediatrics 110:27–35PubMedCrossRef
38.
Hall HI, Rogers JD (1999) Sun protection behaviors among African Americans. Ethn Dis 9:126–131PubMed
39.
Briley JJ Jr, Lynfield YL, Chavda K (2007) Sunscreen use and usefulness in African–Americans. J Drugs Dermatol 6:19–22PubMed
40.
Reis JM ED, Von Muhlen D, Miller ER (2008) Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease. Am J Clin Nutr 88:1469–1477CrossRef
41.
Harris SS (2006) Vitamin D and African Americans. J Nutr 136:1126–1129PubMed
42.
Holick MF, MacLaughlin JA, Clark MB, Holick SA, Potts JT Jr et al (1980) Photosynthesis of previtamin D3 in human skin and the physiologic consequences. Science 210:203–205PubMedCrossRef
43.
Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77:204–210PubMed
44.
O’Riordan DL, Nehl E, Gies P, Bundy L, Burgess K et al (2009) Validity of covering-up sun-protection habits: association of observations and self-report. J Am Acad Dermatol 60:739–744PubMedCrossRef
45.
Oh SS, Mayer JA, Lewis EC, Slymen DJ, Sallis JF et al (2004) Validating outdoor workers’ self-report of sun protection. Prev Med 39:798–803PubMedCrossRef
Metadata
Title
Sun protective behaviors and vitamin D levels in the US population: NHANES 2003–2006
Authors
Eleni Linos
Elizabeth Keiser
Matthew Kanzler
Kristin L. Sainani
Wayne Lee
Eric Vittinghoff
Mary-Margaret Chren
Jean Y. Tang
Publication date
01-01-2012
Publisher
Springer Netherlands
Published in
Cancer Causes & Control / Issue 1/2012
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-011-9862-0

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