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Published in: BMC Geriatrics 1/2017

Open Access 01-12-2017 | Research article

Factors associated to serum 25-hydroxyvitamin D levels among older adult populations in urban and suburban communities in Shanghai, China

Authors: Qun Cheng, Yanping Du, Wei Hong, Wenjing Tang, Huilin Li, Minmin Chen, Songbai Zheng

Published in: BMC Geriatrics | Issue 1/2017

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Abstract

Background

Vitamin D deficiency is widespread in China, particularly among older adults. Factors associated with suboptimal vitamin D levels are not well defined. The present study was a population-based study that included 10 urban and suburban communities in Shanghai, to evaluate vitamin D status and its correlates among older adults.

Method

This cross-sectional study was based on study data for 3924 healthy men and women aged 65−95 years. Anthropometric and socioeconomic data were collected in June−July 2014. Serum 25(OH)D levels were detected using a chemiluminescence immunoassay. The following socioeconomic data were obtained through self-administered questionnaires: education level, lifestyle, residency, and dietary habits. A logistic regression model was used to assess associations between anthropometric factors, socioeconomic factors and serum 25(OH)D levels.

Results

Median levels of serum 25(OH)D in men and women were 22.73 and 19.99 ng/mL, respectively. Vitamin D deficiency was common in subjects, even though data collection was conducted during summer. The general prevalence of serum 25(OH)D levels <20 ng/mL were 35.4% and 50.5% for men and women respectively. The general prevalence of serum 25(OH)D levels <10 ng/mL were 2.73% and 5.9% for men and women respectively. A multivariable model indicated serum 25(OH)D levels ≥20 ng/mL were significantly and positively correlated with male sex, calcium or vitamin D supplementation, and residency in suburban communities. The model also indicated that high level of physical activity was protective factors of vitamin D deficiency for men and milk consumption for women, respectively. By contrast, deficient serum 25(OH)D levels were significantly correlated with education level (lower than primary school) or obesity [body mass index (BMI) ≥ 26.06 kg/m2] for men or women, respectively.

Conclusion

This cross-sectional study of older adults in communities in Shanghai demonstrates that key factors positively correlated with serum 25(OH)D levels ≥20 ng/mL include male sex, residency in suburban communities, calcium or vitamin D supplementation, high physical activity and education level (for men), and dairy consumption and maintenance of normal BMI (for women).
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Literature
1.
go back to reference Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J, IOF Committee of Scientific Advisors (CSA) Nutrition Working Group. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20(11):1807–20.CrossRefPubMed Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J, IOF Committee of Scientific Advisors (CSA) Nutrition Working Group. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20(11):1807–20.CrossRefPubMed
2.
go back to reference Brincat M, Gambin J, Brincat M, Calleja-Agius J. The role of vitamin D in osteoporosis. Maturitas. 2015;80(3):329–32.CrossRefPubMed Brincat M, Gambin J, Brincat M, Calleja-Agius J. The role of vitamin D in osteoporosis. Maturitas. 2015;80(3):329–32.CrossRefPubMed
3.
go back to reference Beveridge LA, Witham MD. Vitamin D and the cardiovascular system. Osteoporos Int. 2013;24(8):2167–80.CrossRefPubMed Beveridge LA, Witham MD. Vitamin D and the cardiovascular system. Osteoporos Int. 2013;24(8):2167–80.CrossRefPubMed
4.
go back to reference Zhang MX, Pan GT, Guo JF, Li BY, Qin LQ, Zhang ZL. Vitamin D Deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients. 2015;7(10):8366–75.CrossRefPubMedPubMedCentral Zhang MX, Pan GT, Guo JF, Li BY, Qin LQ, Zhang ZL. Vitamin D Deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients. 2015;7(10):8366–75.CrossRefPubMedPubMedCentral
5.
go back to reference Khayatzadeh S, Feizi A, Saneei P, Esmaillzadeh A. Vitamin D intake, serum vitamin D levels, and risk of gastric cancer: a systematic review and meta-analysis. J Res Med Sci. 2015;20(8):790–6.CrossRefPubMedPubMedCentral Khayatzadeh S, Feizi A, Saneei P, Esmaillzadeh A. Vitamin D intake, serum vitamin D levels, and risk of gastric cancer: a systematic review and meta-analysis. J Res Med Sci. 2015;20(8):790–6.CrossRefPubMedPubMedCentral
6.
go back to reference Rolf L, Muris AH, Hupperts R, Damoiseaux J. Illuminating vitamin D effects on B-cells - the multiple sclerosis perspective. Immunology. 2016;147(3):275–84. Rolf L, Muris AH, Hupperts R, Damoiseaux J. Illuminating vitamin D effects on B-cells - the multiple sclerosis perspective. Immunology. 2016;147(3):275–84.
7.
go back to reference Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol. 2010;6(10):550–61.CrossRefPubMed Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol. 2010;6(10):550–61.CrossRefPubMed
8.
go back to reference Cheng Q, Zhu YX, Zhang MX, Li LH, PY D, Zhu MH. Age and sex effects on the association between body composition and bone mineral density in healthy Chinese men and women. Menopause. 2012;19(4):448–55.CrossRefPubMed Cheng Q, Zhu YX, Zhang MX, Li LH, PY D, Zhu MH. Age and sex effects on the association between body composition and bone mineral density in healthy Chinese men and women. Menopause. 2012;19(4):448–55.CrossRefPubMed
9.
go back to reference HK L, Zhang Z, Ke YH, He JW, WZ F, Zhang CQ, Zhang ZL. High prevalence of vitamin D insufficiency in China: relationship with the levels of parathyroid hormone and markers of bone turnover. PLoS One. 2012;7(11):e47264.CrossRef HK L, Zhang Z, Ke YH, He JW, WZ F, Zhang CQ, Zhang ZL. High prevalence of vitamin D insufficiency in China: relationship with the levels of parathyroid hormone and markers of bone turnover. PLoS One. 2012;7(11):e47264.CrossRef
10.
go back to reference Yan L, Prentice A, Zhang H, Wang X, Stirling DM, Golden MM. Vitamin D status and parathyroid hormone concentrations in Chinese women and men from north-east of the People's Republic of China. Eur J Clin Nutr. 2000;54(1):68–72.CrossRefPubMed Yan L, Prentice A, Zhang H, Wang X, Stirling DM, Golden MM. Vitamin D status and parathyroid hormone concentrations in Chinese women and men from north-east of the People's Republic of China. Eur J Clin Nutr. 2000;54(1):68–72.CrossRefPubMed
11.
go back to reference Feng X, Guo T, Wang Y, Kang D, Che X, Zhang H, Cao W, Wang P. The vitamin D status and its effects on life quality among the elderly in Jinan, China. Arch Gerontol Geriatr. 2016;62:26–9.CrossRefPubMed Feng X, Guo T, Wang Y, Kang D, Che X, Zhang H, Cao W, Wang P. The vitamin D status and its effects on life quality among the elderly in Jinan, China. Arch Gerontol Geriatr. 2016;62:26–9.CrossRefPubMed
12.
go back to reference Yu S, Fang H, Han J, Cheng X, Xia L, Li S, Liu M, Tao Z, Wang L, Hou L, Qin X, Li P, Zhang R, Su W, Qiu L. The high prevalence of hypovitaminosis D in China: a multicenter vitamin D status survey. Medicine (Baltimore). 2015;94(8):e585.CrossRef Yu S, Fang H, Han J, Cheng X, Xia L, Li S, Liu M, Tao Z, Wang L, Hou L, Qin X, Li P, Zhang R, Su W, Qiu L. The high prevalence of hypovitaminosis D in China: a multicenter vitamin D status survey. Medicine (Baltimore). 2015;94(8):e585.CrossRef
13.
go back to reference Kull M Jr, Kallikorm R, Tamm A, Lember M. Seasonal variance of 25-(OH) vitamin D in the general population of Estonia, a northern European country. BMC Public Health. 2009;9:22.CrossRefPubMedPubMedCentral Kull M Jr, Kallikorm R, Tamm A, Lember M. Seasonal variance of 25-(OH) vitamin D in the general population of Estonia, a northern European country. BMC Public Health. 2009;9:22.CrossRefPubMedPubMedCentral
14.
go back to reference Merlo C, Trummler M, Essig S, Zeller A, Vitamin D. Deficiency in unselected patients from Swiss primary care: a cross-sectional study in TwoSeasons, e0138613. PLoS One. 2015;10(9) Merlo C, Trummler M, Essig S, Zeller A, Vitamin D. Deficiency in unselected patients from Swiss primary care: a cross-sectional study in TwoSeasons, e0138613. PLoS One. 2015;10(9)
15.
go back to reference Choi EY. 25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults. Asia Pac J Clin Nutr. 2012;21:526–35.PubMed Choi EY. 25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults. Asia Pac J Clin Nutr. 2012;21:526–35.PubMed
16.
go back to reference Al-Daghri NM, Aljohani N, Al-Attas OS, Krishnaswamy S, Alfawaz H, Al-Ajlan A, Alokail MS. Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults. Int J Clin Exp Pathol. 2015;8(7):8480–6.PubMedPubMedCentral Al-Daghri NM, Aljohani N, Al-Attas OS, Krishnaswamy S, Alfawaz H, Al-Ajlan A, Alokail MS. Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults. Int J Clin Exp Pathol. 2015;8(7):8480–6.PubMedPubMedCentral
17.
go back to reference Kimlin MG, Lucas RM, Harrison SL, van der Mei I, Armstrong BK, Whiteman DC, Kricker A, Nowak M, Brodie AM, Sun J. The contributions of solar ultraviolet radiation exposure and other determinants to serum 25-hydroxyvitamin D concentrations in Australian adults: the AusD study. Am J Epidemiol. 2014;179(7):864–74.CrossRefPubMed Kimlin MG, Lucas RM, Harrison SL, van der Mei I, Armstrong BK, Whiteman DC, Kricker A, Nowak M, Brodie AM, Sun J. The contributions of solar ultraviolet radiation exposure and other determinants to serum 25-hydroxyvitamin D concentrations in Australian adults: the AusD study. Am J Epidemiol. 2014;179(7):864–74.CrossRefPubMed
18.
go back to reference Robien K, Butler LM, Wang R, Beckman KB, Walek D, Koh WP, Yuan JM. Genetic and environmental predictors of serum 25-hydroxyvitamin D concentrations among middle-aged and elderly Chinese in Singapore. Br JNutr. 2013;109:493–502.CrossRef Robien K, Butler LM, Wang R, Beckman KB, Walek D, Koh WP, Yuan JM. Genetic and environmental predictors of serum 25-hydroxyvitamin D concentrations among middle-aged and elderly Chinese in Singapore. Br JNutr. 2013;109:493–502.CrossRef
19.
go back to reference Ardawi MS, Qari MH, Rouzi AA, Maimani AA, Raddadi RM. Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women. Osteoporos Int. 2011;22(2):463–75.CrossRefPubMed Ardawi MS, Qari MH, Rouzi AA, Maimani AA, Raddadi RM. Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women. Osteoporos Int. 2011;22(2):463–75.CrossRefPubMed
20.
go back to reference Campagna AM, Settgast AM, Walker PF, DeFor TA, Campagna EJ, Plotnikoff GA. Effect of country of origin, age, and body mass index on prevalence of vitamin D deficiency in a US immigrant and refugee population. Mayo Clin Proc. 2013;88(1):31–7.CrossRefPubMed Campagna AM, Settgast AM, Walker PF, DeFor TA, Campagna EJ, Plotnikoff GA. Effect of country of origin, age, and body mass index on prevalence of vitamin D deficiency in a US immigrant and refugee population. Mayo Clin Proc. 2013;88(1):31–7.CrossRefPubMed
21.
go back to reference Cheng Q, Zhu X, Zhang X, Li H, Du Y, Hong W, Xue S, Zhu H. A cross-sectional study of loss of muscle mass corresponding to sarcopenia in healthy Chinese men and women: reference values, prevalence, and association with bone mass. J Bone Miner Metab. 2014;32(1):78–88.CrossRefPubMed Cheng Q, Zhu X, Zhang X, Li H, Du Y, Hong W, Xue S, Zhu H. A cross-sectional study of loss of muscle mass corresponding to sarcopenia in healthy Chinese men and women: reference values, prevalence, and association with bone mass. J Bone Miner Metab. 2014;32(1):78–88.CrossRefPubMed
22.
go back to reference McCullough ML, Weinstein SJ, Freedman DM, Helzlsouer K, Flanders WD, Koenig K, Kolonel L, Laden F, Le Marchand L, Purdue M, et al. Correlates of circulating 25-hydroxyvitamin D: cohort consortium vitamin D pooling project of rarer cancers. Am J Epidemiol. 2010;172:21–35.CrossRefPubMedPubMedCentral McCullough ML, Weinstein SJ, Freedman DM, Helzlsouer K, Flanders WD, Koenig K, Kolonel L, Laden F, Le Marchand L, Purdue M, et al. Correlates of circulating 25-hydroxyvitamin D: cohort consortium vitamin D pooling project of rarer cancers. Am J Epidemiol. 2010;172:21–35.CrossRefPubMedPubMedCentral
23.
go back to reference Larose TL, Chen Y, Camargo CA Jr, Langhammer A, Romundstad P, Mai XM. Factors associated with vitamin D deficiency in a Norwegian population: the HUNT study. J Epidemiol Community Health. 2014;68:165–70.CrossRefPubMed Larose TL, Chen Y, Camargo CA Jr, Langhammer A, Romundstad P, Mai XM. Factors associated with vitamin D deficiency in a Norwegian population: the HUNT study. J Epidemiol Community Health. 2014;68:165–70.CrossRefPubMed
24.
go back to reference Abboud M, Puglisi DA, Davies BN, Rybchyn M, Whitehead NP, Brock KE, Cole L, Gordon-Thomson C, Fraser DR, Mason RS. Evidence for a specific uptake and retention mechanism for 25-hydroxyvitamin D (25OHD) in skeletal muscle cells. Endocrinology. 2013;154(9):3022–30.CrossRefPubMed Abboud M, Puglisi DA, Davies BN, Rybchyn M, Whitehead NP, Brock KE, Cole L, Gordon-Thomson C, Fraser DR, Mason RS. Evidence for a specific uptake and retention mechanism for 25-hydroxyvitamin D (25OHD) in skeletal muscle cells. Endocrinology. 2013;154(9):3022–30.CrossRefPubMed
25.
go back to reference Cheng TY, Millen AE, Wactawski-Wende J, Beresford SA, LaCroix AZ, Zheng Y, Goodman GE, Thornquist MD, Neuhouser ML. Vitamin D intake determines vitamin d status of postmenopausal women, particularly those with limited sun exposure. J Nutr. 2014;144(5):681–9.CrossRefPubMedPubMedCentral Cheng TY, Millen AE, Wactawski-Wende J, Beresford SA, LaCroix AZ, Zheng Y, Goodman GE, Thornquist MD, Neuhouser ML. Vitamin D intake determines vitamin d status of postmenopausal women, particularly those with limited sun exposure. J Nutr. 2014;144(5):681–9.CrossRefPubMedPubMedCentral
26.
go back to reference Ardawi MS, Sibiany AM, Bakhsh TM, Qari MH, Maimani AA. High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors. Osteoporos Int. 2012;23(2):675–86.CrossRefPubMed Ardawi MS, Sibiany AM, Bakhsh TM, Qari MH, Maimani AA. High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors. Osteoporos Int. 2012;23(2):675–86.CrossRefPubMed
27.
go back to reference Ke L, Mason RS, Mpofu E, Dibley M, Li Y, Brock KE. Vitamin D and parathyroid hormone status in a representative population living in Macau, China. J Steroid Biochem Mol Biol. 2015;148:261–8.CrossRefPubMed Ke L, Mason RS, Mpofu E, Dibley M, Li Y, Brock KE. Vitamin D and parathyroid hormone status in a representative population living in Macau, China. J Steroid Biochem Mol Biol. 2015;148:261–8.CrossRefPubMed
28.
go back to reference Chan J, Jaceldo-Siegl K, Fraser GE. Serum 25-hydroxyvitamin D status of vegetarians, partial vegetarians, and nonvegetarians: the Adventist health Study-2. Am J Clin Nutr. 2009;89(5):1686S–92S.CrossRefPubMedPubMedCentral Chan J, Jaceldo-Siegl K, Fraser GE. Serum 25-hydroxyvitamin D status of vegetarians, partial vegetarians, and nonvegetarians: the Adventist health Study-2. Am J Clin Nutr. 2009;89(5):1686S–92S.CrossRefPubMedPubMedCentral
29.
go back to reference EM B-B, AM V, NL v d Z, JP v W, KM S, AC H, SC v D, AW E, E S, NM v S, N v d V, AG U, P L, EJ F, RA D-R, de Groot LC. Relative importance of summer sun exposure, vitamin D intake, and genes to vitamin D status in Dutch older adults: the B-PROOF study. J Steroid Biochem Mol Biol. 2016;164:168–76.CrossRef EM B-B, AM V, NL v d Z, JP v W, KM S, AC H, SC v D, AW E, E S, NM v S, N v d V, AG U, P L, EJ F, RA D-R, de Groot LC. Relative importance of summer sun exposure, vitamin D intake, and genes to vitamin D status in Dutch older adults: the B-PROOF study. J Steroid Biochem Mol Biol. 2016;164:168–76.CrossRef
30.
go back to reference Lips P. Interaction between vitamin D and calcium. Scand J Clin Lab Invest Suppl. 2012;243:60–4.PubMed Lips P. Interaction between vitamin D and calcium. Scand J Clin Lab Invest Suppl. 2012;243:60–4.PubMed
31.
go back to reference Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet. 1989;2:1104–5.CrossRefPubMed Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet. 1989;2:1104–5.CrossRefPubMed
32.
go back to reference Need AG, Morris HA, Horowitz M, et al. Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr. 1993;58:882–5.PubMed Need AG, Morris HA, Horowitz M, et al. Effects of skin thickness, age, body fat, and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr. 1993;58:882–5.PubMed
33.
go back to reference Pazaitou-Panayiotou K, Papapetrou PD, Chrisoulidou A, Konstantinidou S, Doumala E, Georgiou E, Panagiotou V, Sotiriadou E, Mavroudi E, Apostolaki-Christopoulou M. Height, whole body surface area, gender, working outdoors, and sunbathing in previous summer are important determinants of serum 25-hydroxyvitamin D levels. Exp Clin Endocrinol Diabetes. 2012;120(1):14–22.CrossRefPubMed Pazaitou-Panayiotou K, Papapetrou PD, Chrisoulidou A, Konstantinidou S, Doumala E, Georgiou E, Panagiotou V, Sotiriadou E, Mavroudi E, Apostolaki-Christopoulou M. Height, whole body surface area, gender, working outdoors, and sunbathing in previous summer are important determinants of serum 25-hydroxyvitamin D levels. Exp Clin Endocrinol Diabetes. 2012;120(1):14–22.CrossRefPubMed
34.
go back to reference Van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, Lips P. Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn study. Am J Clin Nutr. 2007;85:755–61.PubMed Van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, Lips P. Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn study. Am J Clin Nutr. 2007;85:755–61.PubMed
Metadata
Title
Factors associated to serum 25-hydroxyvitamin D levels among older adult populations in urban and suburban communities in Shanghai, China
Authors
Qun Cheng
Yanping Du
Wei Hong
Wenjing Tang
Huilin Li
Minmin Chen
Songbai Zheng
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0632-z

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