Abstract
In this review, reports were retrieved in which vitamin D status, as assessed by serum 25-hydroxyvitamin D [25(OH)D] levels, was measured in South African population groups with varied skin colours and ethnicities. Healthy children and adults were generally vitamin D-sufficient [25(OH)D level >50 nmol/L] but the majority of those aged above 65 years were deficient. A major role for exposure to solar ultraviolet radiation (UVR) in determining 25(OH)D levels was apparent, with the dietary contribution being minor. Limited data exist regarding the impact of recent changes in lifestyles on vitamin D status, such as urbanisation. With regard to disease susceptibility, 11 of 22 relevant publications indicated association between low 25(OH)D levels and disease, with deficiency most notably found in individuals with tuberculosis and HIV-1. Information on the relationship between vitamin D receptor variants and ethnicity, disease or treatment response in the South African population groups demonstrated complex interactions between genetics, epigenetics and the environment. Whether vitamin D plays an important role in protection against the range of diseases that currently constitute a large burden on the health services in South Africa requires further investigation. Only then can accurate advice be given about personal sun exposure or dietary vitamin D supplementation.
Highlights
Vitamin D deficiency is a risk factor for rickets in children and osteomalacia in adults [1]
Vitamin D deficiency may be the result of both HIV-1 infection and loss of HIV-1 killing mechanisms with a further decrease in CD4+ T cells [72]
A systematic search of the published literature provided limited but important information relating to the vitamin D status of the South African population
Summary
Vitamin D deficiency is a risk factor for rickets in children and osteomalacia in adults [1]. With the recognition that the active form of vitamin D is immunoregulatory, vitamin D deficiency has been proposed to increase the likelihood of a wide range of common human disorders [2,3], including various autoimmune, infectious and cardiovascular diseases, and internal cancers, several of which occur in South Africa at rates exceeding those reported globally. While there has been considerable research on vitamin D in developed countries [4,5], this has not been matched in developing countries. Res. Public Health 2016, 13, 1019; doi:10.3390/ijerph13101019 www.mdpi.com/journal/ijerph
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