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Vitamin D deficiency in Northern Sweden: a cross-sectional study of an immigrant population at latitude 63° N, including an open partially randomized, controlled trial studying the effect of supplementation with different doses of cholecalciferol
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Vitamin D is a prohormone that plays a key role in the calcium and phosphate balance and has physiological functions throughout the entire body. Vitamin D is supplied by exposure to ultraviolet light or by food. The prevalence of vitamin D deficiency in immigrants in Northern Sweden was unknown. There was no consensus on how to define or treat vitamin D deficiency and no pure preparations of cholecalciferol available in Sweden.

Aims: To study the prevalence and determinants of vitamin D deficiency in immigrants of African and Middle Eastern origin, to examine associations between vitamin D status and muscle strength, anxiety, depression and quality of life, and to determine the effect of supplementation with cholecalciferol on 25-hydroxyvitamin D3 [25(OH)D] and vitamin D status.

Methods: 1. A cross-sectional, population-based study. Immigrants ages 25-65 from Africa and the Middle East (n=1306) living in Umeå, Sweden, were invited to participate. A total of 111 men and 106 women (16.5%) participated. 25(OH)D was measured by LC-MsMs. Anthropometry, medical, socioeconomic and lifestyle data was registered. Examinations: lower limb muscle strength, grip strength, HAD, health-related quality of life (QoL) 2. An open, partially randomized, controlled trial including immigrants from Africa or the Middle East, 192 subjects screened, 160 included and 147 completed the study. Intervention: cholecalciferol 12±2 weeks, 4 parallel groups; Group 1: 25(OH)D <25nmol/L: 10000 IU/d, Groups 2a and 2b: 25(OH)D 25-49 nmol/L: 2000 IU/d or 2000 IU/w, Group 3: 25(OH)D 50-74 nmol/L: 2000 IU/d.

Results: Twelve percent of the immigrants showed a vitamin D deficiency (25(OH)D ˂25 nmol/L) and 73 % showed 25(OH)D ˂50 nmol/L. Vitamin D deficiency was twice as common in African immigrants as in the Middle Eastern group. Vitamin D deficiency was associated with intake of fatty fish less than once a week, absence of travel abroad and use of long-sleeved clothing in summer. Lower limb muscle strength was associated with 25(OH)D levels and weaker grip strength was associated with vitamin D deficiency. Vitamin D deficiency was not associated with anxiety, depression or QoL in the total immigrant population. In Middle Eastern women, in whom prevalence of anxiety was higher, anxiety was associated with 25(OH)D ≤49 nmol/L. Oral cholecalciferol was effective in increasing 25(OH)D. At study end, 100% in Group 1, 89% in Group 2a, 55% in Group 2b and 96% in Group 3 reached adequate vitamin D status (25(OH)D ˃50 nmol/L). In Group 1; 62 % reached 25(OH)D ≥125 nmol/L.

Conclusions: Vitamin D deficiency and insufficiency was common in the immigrant group and no difference was shown between men and women. A diet including a high intake of fatty fish was most important in avoiding vitamin D deficiency. Vitamin D status was associated with muscle strength in all immigrants. Vitamin D deficiency was not associated with anxiety, depression or QoL in the immigrants. In female immigrants from the Middle East, anxiety was associated with 25(OH)D levels ≤49 nmol/L. Supplementation with cholecalciferol 2000 IU/day for three months was safe in healthy individuals with initial 25(OH)D 25-49 nmol/L, but monitoring is warranted since 11 % did not attain sufficient vitamin D status. The dose 10 000 IU/day in patients with initial 25(OH)D <25 nmol/L was unnecessarily high.

Place, publisher, year, edition, pages
Umeå: Umeå University, Department of Public Health and Clinical Medicine , 2018. , p. 86
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1964
Keywords [en]
vitamin D deficiency, 25-hydroxyvitamin D, cross-sectional study, immigrant, muscle strength, grip strength, anxiety, depression, health related quality of life, clinical trial, cholecalciferol
National Category
General Practice
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-147575ISBN: 978-91-7601-878-1 (print)OAI: oai:DiVA.org:umu-147575DiVA, id: diva2:1204653
Public defence
2018-06-01, Sal 933, målpunkt B, 9 tr, Norrlands Universitetssjukhus, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-05-09 Created: 2018-05-08 Last updated: 2018-11-09Bibliographically approved
List of papers
1. Prevalence of vitamin D deficiency and its association with nutrition, travelling and clothing habits in an immigrant population in Northern Sweden
Open this publication in new window or tab >>Prevalence of vitamin D deficiency and its association with nutrition, travelling and clothing habits in an immigrant population in Northern Sweden
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2016 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 3, p. 373-379Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study prevalence and determinants of vitamin D deficiency in immigrants from Africa and the Middle East living in Umeå, Sweden.

DESIGN: Cross-sectional population based.

SETTING: Umeå, Sweden (63° N).

SUBJECTS/METHODS: Immigrants aged 25-65 years from nine countries in Africa or the Middle East (n=1306) were invited. A total of 111 men and 106 women (16.5%) completed the study. S-25-hydroxyvitamin D3 was measured with HPLC. Anthropometry, medical, socioeconomic and lifestyle data were registered.

RESULTS: Vitamin D status was insufficient or deficient in 73% of the participants. Specifically, 12% had vitamin D deficiency (25(OH)D3<25 nmol/l), and only 3.7% had optimal vitamin D status (25(OH)D3 75-125 nmol/l). Mean 25(OH)D3 level was 41.0 nmol/l (±16.6) with no difference between sexes. Levels of 25(OH)D3 were lower (P=0.030) and vitamin D deficiency was twice as common in immigrants from Africa compared with those from the Middle East. In the multiple regression analysis, vitamin D deficiency was significantly associated with low fatty fish intake (OR 4.31, 95% CI 1.61-11.55), not travelling abroad (OR 3.76, 95% CI 1.18-11.96) and wearing long-sleeved clothes in summer (OR 3.15, 95% CI 1.09-9.12).

CONCLUSIONS: The majority of immigrants from Africa and the Middle East who live in northern Sweden have vitamin D deficiency or insufficiency. Our results are consistent with sun exposure and a diet with high intake of fatty fish being most important in avoiding vitamin D deficiency.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-112102 (URN)10.1038/ejcn.2015.176 (DOI)000371667700014 ()26508457 (PubMedID)
Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2018-06-07Bibliographically approved
2. Vitamin D is associated with lower limb muscle strength and grip strength in Middle Eastern and African-born immigrants in Sweden
Open this publication in new window or tab >>Vitamin D is associated with lower limb muscle strength and grip strength in Middle Eastern and African-born immigrants in Sweden
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-147571 (URN)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-06-09
3. Associations between vitamin D status and anxiety, depression and health related quality of life in an immigrant population. A cross-sectional study from Sweden
Open this publication in new window or tab >>Associations between vitamin D status and anxiety, depression and health related quality of life in an immigrant population. A cross-sectional study from Sweden
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-147572 (URN)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-06-09
4. A randomised trial of vitamin D among immigrants in Sweden: response to treatment - a question of starting point and dose
Open this publication in new window or tab >>A randomised trial of vitamin D among immigrants in Sweden: response to treatment - a question of starting point and dose
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-147573 (URN)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-06-09

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