Sun Exposure Index Research Articles

Sun Exposure Characteristics among the Indian Population Who Are at Risk for Type 2 Diabetes Mellitus: A Population-Based Cross-Sectional Study

Abstract Background and Aim: Evidence suggests a beneficial effect of sun exposure on type 2 diabetes mellitus (DM). However, little is known about the characteristics of sun exposure among DM patients or individuals at risk of developing DM. The aim of this study was to analyze the sun exposure behaviors of individuals diagnosed with DM and those susceptible to developing DM within a semi-urban community in North India. Materials and Methods: A population-based cross-sectional study was conducted in northern India with 494 participants aged 25–60, with or without DM. The participants’ sun exposure characteristics were assessed through a sunlight exposure questionnaire, and total sun exposure in a day was computed using the veritable sun exposure (VSE) index. Fasting blood sugar, anthropometric measurements, and demographic details were also collected. Results: The study had 56.5% female participants, and 9.1% of the participants had DM. The VSE of the study participants ranged from 0.01 to 0.81, with a mean of 0.15 (±0.14) and a median of 0.10, indicating that more than half of the study samples had less than 10% h/day of sunlight exposure. The use of sunscreen, gender, and disease status all influenced VSE. Our data suggest that the characteristics of sun exposure among Indians significantly deviate from standard recommendations. Conclusion: Our results propose a need for evidence-based guidelines and policies that promote awareness about sun exposure among DM patients as well as those at risk of developing DM. Nevertheless, these findings need to be validated through large-scale observational studies.

Low serum vitamin D in North Indian multi-drug resistant pulmonary tuberculosis patients: the role of diet and sunlight

Background: Tuberculosis (TB) and malnutrition are major global health problems, with multidrug-resistant (MDR) TB complicating international efforts. The role of vitamin D in susceptibility to and as an adjunctive treatment for TB is being studied extensively, although no study has included MDR-TB patients in context to dietary profile with vitamin D levels and sunlight exposure.Objective: This study aimed to estimate vitamin D serum levels and examine their association with dietary intake of vitamin D and sun exposure in patients with MDR-TB.Methods: North Indian participants were enrolled in three groups: MDR-TB, drug-susceptible pulmonary TB (DS-PTB), and healthy controls. All consenting participants underwent the estimation of macro- and micronutrient intake and sunlight exposure using structured questionnaires. Serum biochemistry, including 25-hydroxyvitamin D and calcium levels, was measured, and the correlation between variables was determined.Results: 747 participants were enrolled. Significant differences among the three groups were found in mean serum 25-hydroxyvitamin D levels, body mass index, macronutrient intake, dietary vitamin D and calcium content, and sun exposure index (SEI). All except sun exposure (SEI was highest in DS-PTB patients) were found to follow the trend: MDR-TB < DS-PTB < healthy controls. The mean serum vitamin D levels of all groups were deficient and correlated positively with dietary intake and SEI.Conclusion: In this study’s we found significant association of serum vitamin D concentrations, dietary intake and sunlight exposure in MDR-TB, DS-PTB patients and healthy controls. Dietary intake may be more important than sun exposure in determining serum levels. However, the significance of this finding is uncertain. Further studies are required to confirm the association, direction, and potential for vitamin D supplementation to treat or prevent MDR-TB infection.

Translation and Validation of the Dutch Version of the Sun Exposure and Protection Index

Introduction: Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the person’s propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research. Methods: Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer – Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearman’s Rho. Internal consistency was assessed with Cronbach’s Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out 3 weeks later, and scores were compared with Cohen’s weighted Kappa. Results: Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76). Conclusion: In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usages in daily clinical practice and research to evaluate individual ultraviolet exposure and measure a person’s propensity to limit it.

Frequency of Vitamin D Receptor Gene Polymorphisms in a Population with a very High Prevalence of Vitamin D Deficiency, Obesity, Diabetes and Hypertension.

Although vitamin D levels and underlying vitamin D receptor (VDR) genetic polymorphisms have been linked to many common diseases including obesity, the association remains unclear. There is also co-existence of pathologically high proportions of obesity and vitamin D deficiency conditions in our UAE society. We therefore aimed to determine the genotypes and allele percentage frequency distribution of four polymorphisms-FokI, BsmI, ApaI and TaqI-in the VDR gene in healthy Emirati individuals and their association with vitamin D levels and chronic conditions including diabetes mellitus, hypertension and obesity. 277 participants who were part of a randomized controlled trial had their assessment that included clinical and anthropometric data. Whole blood samples were taken for measurements of vitamin D [25(OH) D], four vitamin D receptor gene polymorphism SNPs, including BsmI, FokI, TaqI and ApaI, metabolic and inflammatory markers and related biochemical variables. Multiple logistic regression analysis was used to assess the influence of vitamin D receptor gene SNPs on vitamin D status after adjusting for clinical parameters known to influence vitamin D status in the study population. Overall, 277 participants with a mean (±SD) age of 41 ± 12, 204 (74%) of them being female, were included in the study. There were statistically significant differences in vitamin D concentrations between different genotypes of the four VDR gene polymorphisms (p < 0.05). There were, however, no statistically significant differences in vitamin D concentrations between subjects with and those without the four VDR gene polymorphisms genotype and alleles except for AA and AG and allele G in Apal SNP (p < 0.05). Multivariate analysis revealed no significant independent associations between vitamin D status and the four VDR gene polymorphisms after adjusting for dietary intake, physical activity, sun exposure, smoking and body mass index. In addition, no significant differences were found in the frequency of the genotypes and alleles of the four VDR genes among patients with obesity, diabetes and hypertension compared to those without these medical conditions. Although we found statistically significant differences in vitamin concentrations between different genotypes of the four VDR gene polymorphisms, multivariate analysis revealed no association after adjusting for clinical parameters known to influence vitamin D status. Furthermore, no association was found between obesity and related pathologies and the four VDR gene polymorphisms.

Validation of the Sun Exposure and Protection Index (SEPI) in Greek: An Instrument for Measuring Children’s Sun Protection Propensity

Skin cancer, the most common type of cancer worldwide, has been linked to overexposure to ultraviolet radiation (UVR) without protection. As skin cancer is a preventable type of cancer, there is a pressing need to adopt health-promoting behaviors early in life. The Sun Exposure and Protection Index (SEPI) is an instrument for evaluating adults’ sun exposure habits and the propensity to increase sun protection with widely accepted validity and reliability in Swedish, English, and German. The present study aims to validate SEPI with children in Greek. Data was collected from 127 primary school students in Cyprus who completed the instrument twice within two weeks. Internal consistency calculated by Cronbach’s alpha was 0.69 for all 13 items included in SEPI. A statistically significant (p &lt; 0.01) strong and positive correlation coefficient (Pearson’s r = 0.63) was measured between the total scores for parts 1 and 2. Test–retest stability was high and significant (ρ &gt; 0.5, p &lt; 0.01) for all items but one. In conclusion, the Greek version of SEPI demonstrates reasonable internal consistency, as Cronbach’s alpha is at a relatively acceptable level. It can be used for evaluating prevention interventions assessing sun exposure habits, and the propensity to increase sun protection among primary school students.

Sun Exposure Is Associated with Reduced Breast Cancer Risk among Women Living in the Caribbean: The Atabey Study in Puerto Rico.

Though inconsistent, there is evidence that sun exposure is associated with reduced breast cancer risk. Previous studies have been conducted in geographical regions with seasonal variation in UV radiation, including periods of low to no exposure, and among participants mostly of European descent. Puerto Rico has no significant seasonal fluctuation, with continuous exposure to very high UV radiation. We conducted a population-based case-control study of breast cancer among women in metropolitan San Juan, Puerto Rico, examining a cumulative sun exposure index (SEI) based on a comparison of reflectance of sun-exposed and non-exposed skin. A chromameter was used to measure skin reflectance and estimate the difference between constitutive (unexposed) and facultative (exposed) skin pigmentation in 307 cases and 328 controls. Breast cancer risk factors were ascertained with interviewer-administered questionnaires. OR and 95% confidence intervals (CI) were estimated with unconditional logistic regression. Adjusted breast cancer odds were lower for the highest tertile of the SEI (ORadj = 0.47; 95% CI, 0.29-0.74). Results were similar within strata of estrogen receptor status. In analyses stratified by constitutive skin pigmentation, among participants with darker skin color, breast cancer risk was lower with more sun exposure (ORadj = 0.33; 95% CI, 0.16-0.70). We found lower risk of breast cancer associated with greater sun exposure in a population living with high, continuous sun exposure. This beneficial finding should be placed in the context of other effects of sun exposure. Sun exposure is a modifiable factor that may contribute, directly or indirectly, to lower breast cancer risk.

Genetic, sociodemographic and lifestyle factors associated with serum 25-hydroxyvitamin D concentrations in Brazilian adults: the Pró-Saúde Study.

This study aims to investigate factors associated with serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian adults considering sociodemographic and lifestyle factors, as well as vitamin D-related single nucleotide polymorphisms (SNPs). This is a cross-sectional study (n = 491; 34-79y; 251 women), nested within a prospective cohort (Pró-Saúde Study). Associations between serum 25(OH)D and sociodemographic characteristics, diet, use of supplement, physical activity, season of blood collection, body fat, skin type, sun exposure index, and SNPs CYP2R1-rs10741657 and GC-rs2282679 were explored by multiple linear regression. The prevalence of serum 25(OH)D < 50nmol/L was 55%. Serum 25(OH)D was lower among women (β = -4.38; 95%CI: -8.02; -0.74), those with higher visceral fat (β = -4.02; 95%CI: -5.92; -2.12), and those with AC and CC genotypes for GC-rs2282679 (β = -6.84; 95%CI: -10.09; -3.59; β = -10.63; 95%CI: -17.52; -3.74, respectively). Factors directly associated with serum 25(OH)D included summer (β = 20.14; 95%CI: 14.38; 25.90), intermediate skin type (β = 6.16; 95%CI: 2.52; 9.80), higher sun exposure (β = 0.49; 95%CI: 0.22; 0.75), vitamin D intake (β = 0.48; 95%CI: 0.03; 0.93), and physical activity (β = 4.65; 95%CI: 1.54; 7.76). Besides physical activity, diet, and sun exposure, non-modifiable factors, such as GC genotypes must be considered when evaluating vitamin D insufficiency in mixed-race populations. Moreover, high visceral fat in association with poorer vitamin D status deserve attention given that both conditions are unfavorably related with chronic and acute health outcomes.

Period of Sun Exposure and Vitamin D Status among the Rural Elderly Women of West Bengal, India.

Introduction:Vitamin D deficiency has been found to be prevalent among Indian elderly women. Aging has a significant association with decreased concentration of 7-dehydrocholesterol, the precursor of Vitamin D3 in the skin.Objective:The aim is to find out the association between the period of sun exposure and serum 25(OH) D level among rural elderly women of West Bengal, India.Subjects and Methods:The present study was conducted among 236 elderly women aged between 60 and 70 years residing at Amdanga Block, North 24th Parganas district of West Bengal, India. They were assessed for their period of sun exposure and serum 25(OH) D level.Results:The sun exposure index was low from sufficient to deficient Vitamin D status groups, but they were insignificant (P = 0.09). Spearman's correlation test revealed significant positive relationship (0.183 [P = 0.005]) between sun exposure and serum 25(OH) D level.Conclusion:Therefore, for maintaining optimum serum 25(OH) D level, adequate sun exposure for this population is needed, particularly for the individuals having suboptimal Vitamin D status.

Validation of SEPI in German-A German Translation of the Sun Exposure and Protection Index.

The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test–retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach’s alpha, for the baseline responses was 0.70 (95% C.I: 0.63–0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66–0.78) for part 2 (propensity to increase sun protection). Test–retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.

Vitamin D deficiency during pregnancy and its associated factors among third trimester Malaysian pregnant women.

BackgroundDespite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia.MethodsInformation on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30–50 nmol/L), and sufficient (≥ 50 nmol/L).ResultsOf the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93–0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05–0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency.ConclusionVitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences.

Sun exposure, skin lesions and vitamin D production: evaluation in a population of fishermen

AbstractBackground: Exposure to UVR provides benefits related to vitamin D synthesis, but also causes harms, since UVB is considered a complete carcinogen. There is no definition of the level of sun exposure and the proportion of exposed body required for proper synthesis of vitamin D in the skin without causing it damage.Objectives: This study aims to analyze the sun exposure index, vitamin D levels and clinical changes in the skin caused by constant sun exposure in the fishermen population.Methods: It is a cross-sectional, observational and analytical study The sample consisted of fishermen and was calculated in 174 individuals. The questionnaire was applied, the dermatological examination was carried out and the examinations of calcidiol, parathyroid hormone, calcium and phosphorus were requested. Data were expressed as percentages. The comparative analysis was done through the Chi-square test, and the correlations were established through the Pearson's linear coefficient.Results: We observed that there was vitamin D deficiency in a small part of the cases (11.46%), and the frequency of diagnosis of skin cancer was 2.7% of the cases surveyed.Study limitations: The difficulty in categorizing the sun exposure index.Conclusion: The fact that fishermen expose themselves to the sun chronically and have been exposed to the sun for more than 15 years, between 21 and 28 hours a week, and without photoprotection, were indicative factors for protection against vitamin D deficiency. Chronic exposure to sun and high vitamin levels D may be indicative of protection of this population against skin cancer.

Sun Exposure and Protection Index (SEPI) and Self-Estimated Sun Sensitivity

The incidence of skin cancer is increasing worldwide, mostly because of increasing exposure to ultraviolet (UV) radiation from the sun. The Sun Exposure and Protection Index (SEPI) questionnaire, developed in Linköping and validated in Sweden and Australia, is used to map sun habits, sun protection behaviour, and readiness to increase sun protection. We sought to examine differences in sun habits or sun protection behaviour and propensity to increase sun protection, based on SEPI as related to self-estimated skin UV sensitivity according to the Fitzpatrick classification. The study population comprised students at Linköping University, who were asked to complete the SEPI questionnaire. We examined differences in sun habits and sun protection behaviour according to skin type and gender. Individuals with lower UV sensitivity had significantly riskier sun habits and sun protection behaviour and were significantly less likely to increase sun protection. Women spent significantly more time tanning than men, more time in the midday sun, used sunscreen more frequently, and were more likely to seek the shade for sun protection. Individuals with higher UV sensitivity were significantly more likely to increase sun protection; individuals with low UV sensitivity tended to have a riskier attitude to sunbathing. In conclusion, self-estimated skin type and gender are important factors influencing sun exposure habits and sun protection behaviour.

Association of Sun Exposure, Skin Colour and Body Mass Index with Vitamin D Status in Individuals Who Are Morbidly Obese.

Vitamin D deficiency is a common issue, particularly in obese populations, and is tested by assessing serum 25(OH)D concentrations. This study aimed to identify factors that contribute to the vitamin D status in fifty morbidly obese individuals recruited prior to bariatric surgery. Data collected included serum 25(OH)D concentrations, dietary and supplement intake of vitamin D, sun exposure measures, skin colour via spectrophotometry, and genotype analysis of several single nucleotide polymorphisms in the vitamin D metabolism pathway. Results showed a significant correlation between serum 25(OH)D concentrations and age, and serum 25(OH)D and ITAC score (natural skin colour). Natural skin colour accounted for 13.5% of variation in serum 25(OH)D, with every 10° increase in ITAC score (i.e., lighter skin) leading to a 9 nmol/L decrease in serum 25(OH)D. Multiple linear regression using age, ITAC score, and average UV index in the three months prior to testing, significantly predicted serum 25(OH)D concentrations (R2 = 29.7%). Single nucleotide polymorphisms for all vitamin D genes tested, showed lower serum 25(OH)D for those with the rare genotype compared to the common genotype; this was most pronounced for fok1 and rs4588, where those with the rare genotype were insufficient (<50 nmol/L), and those with the common genotype were sufficient (≥50 nmol/L). Assessing vitamin D status in individuals with morbid obesity requires testing of 25(OH)D, but potential risk factors for this population include natural skin colour and age.

Visceral and subcutaneous fat mass association with serum 25(OH)D concentrations in Brazilian adults

Vitamin D status is influenced by a number of factors including dietary intake, skin pigmentation and sun exposure. Serum concentration of 25(OH)D may also decrease due to its sequestration by fat tissue. We herein investigated whether fat compartments (visceral and subcutaneous) are differently associated with vitamin D status. We evaluated 514 adults (33–79 y; 266 women and 248 men) who are part of a cohort of employees at a university in Rio de Janeiro, the “Estudo Pró‐Saúde”. Serum 25(OH) concentrations were analyzed by using a chemiluminescent enzyme‐labeled immunometric assay. Fat distribution was assessed by DXA (IDXA, GE Health Care). Analysis of visceral adipose tissue (VAT) was performed by CoreScan VAT software. Total subcutaneous adipose tissue (SAT) was obtained by subtracting the visceral fat from total fat mass of each individual. An objective estimate of natural and sun‐induced skin color was measured by reflectance colorimetry using a Chroma Meter CR‐400 (Konica Minolta) followed by calculation of Individual Typology Angle (ITA°) and Sun Exposure Index (SEI). Serum 25(OH)D association with visceral and subcutaneous fat mass was investigated using multivariate linear regression models that also included ITA°, SEI, month and year of blood collection, as independent variables. Additionally, differences in mean serum 25(OH)D by quartiles of visceral and subcutaneous fat mass were evaluated by ANCOVA with adjustment for month and year of blood collection, and SEI. 72% of the participants were overweight or obese, 54% had serum 25(OH)D concentrations below 20ng/ml and 92% below 30ng/ml. Both SAT (β=−0.129, P=0.022) and VAT (β=−0.109, P=0.046) appeared as significant predictors of serum 25(OH)D in a stepwise linear regression that also tested ITA°, SEI, month and year of blood collection, as independent variables. Compared to the first quartile of SAT (&lt;20.6Kg of SAT; 22.87±0.69ng/ml), individuals in the second, third and fourth quartiles had lower serum 25(OH)D (19.14±0.69, 18.56±0.69 and 16.77±0.69ng/ml, respectively, p&lt;0.001). Compared to the first quartile of VAT (&lt;0.7Kg of VAT; 20.70±0.71ng/ml), only individuals in the fourth quartile had lower serum 25(OH)D (17.24±0.71ng/ml, P&lt;0.01). Having SAT or VAT higher than median (26.0Kg and 1.15Kg, respectively) significantly increased the chance of having serum 25(OH)D lower than 20ng/mL (SAT: OR 2.00; 95% CI 1.41–2.86 and VAT: OR 1.58; 95% CI 1.11–2.24; P&lt;0.05) or lower than 30ng/mL (SAT: OR 2.05; 95% CI 1.05–4.00 and VAT: OR 2.29; 95% CI 1.16–4.52; P&lt;0.05). Our results suggest that the excess of both subcutaneous and visceral fat compartments may contribute to decrease serum 25(OH)D concentrations, independently of skin pigmentation and sun exposure.Support or Funding InformationFundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, grant number E‐26/102.201/2013 and E‐26/110.116/2014, for FFB), Brazil.

Prolonged Exposure Dermatosis: Reporting High Incidence of an Undiagnosed Facial Dermatosis on a Winter Wilderness Expedition

Previously unclassified inflammatory skin lesions referred to as sun bumps have been observed throughout the year on participants of wilderness trips; however, the underlying cause and diagnosis remain unclear. The purpose of this prospective observational study was to document the incidence, characteristics, and risk factors associated with these skin lesions as they occurred on a winter wilderness expedition. For this study, the lesions were defined as pruritic or erythematous skin lesions occurring while in the wilderness. Seventy-four participants in a wilderness ski touring course in Wyoming fully completed a 44-question written survey concerning occurrence and risk factors for these lesions. Weather information and photographs were collected. Twenty-six percent of participants had similar lesions. The lesions were described as edematous pale papules and plaques with erosions and crusts on an erythematous background. The face was involved in 90% of affected persons. Lesions occurred after an average of 8.7 days in the wilderness and resolved 10.6 days later. Skin that was less prone to sunburn was associated with a decreased incidence (odds ratio 0.44). No association could be found between lesion incidence and history of polymorphous light eruption, sun exposure, ambient temperature, affected contacts, sex, or body mass index. Overall, the lesions were common among study participants but occurred only after prolonged exposure to wilderness conditions. It was not possible to classify the skin condition as an example of any known diagnosis. We propose the name "prolonged exposure dermatosis" for this condition until further studies better define its etiology, prevention, and treatment.

Widespread 25-hydroxyvitamin D deficiency in affluent and nonaffluent pregnant Indian women.

Objectives. This cross-sectional study primarily aimed to assess vitamin D adequacy in the third trimester of pregnancy using 25-hydroxyvitamin D (25(OH)D) and explore lifestyle characteristics (sun exposure index, diet, and economic indicators) associated with serum 25(OH)D. The secondary aim was to examine the relationship of serum 25(OH)D with birth weight and gestational age. Methods. Serum 25(OH)D was measured by chemiluminescent immunoassay in 150 pregnant women from Mumbai. Sun exposure index was computed. Dietary calcium, phytate : calcium ratio, and dietary phosphorus was calculated using the 24-hour diet recall method. Results. All women had 25(OH)D levels < 30.00 ng/ml. Multivariable linear regression showed that nonaffluent women had poorer 25(OH)D status than their affluent counterparts (β = −0.20; P = 0.03). Higher sun exposure index was associated with higher 25(OH)D concentrations (β = 0.31; P < 0.001), which remained significant after controlling for covariates. At the bivariate level, mothers of infants weighing <2500 g had lower serum 25(OH)D concentrations compared to mothers whose infants weighed ≥2500 g (P = 0.02). This association became non-significant after controlling for covariates. Conclusions. Vitamin D deficiency was universally prevalent in the cohort studied. There is a need to develop culturally sensitive strategies for improving the 25(OH)D status.

Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara, Turkey

BackgroundLack of sun exposure is one of the primary causes of epidemic vitamin D deficiency worldwide. The aim of this study was to investigate vitamin D status and seasonal changes in summer and winter in office workers. MethodsThis study was conducted in Ankara located at 39°52ʹ30ʺ N, 32°52ʹ E. The study consisted of 118 premenopausal women and men aged between 21 and 52 years-old. Seasonal changes were evaluated in August and February. Fasting serum was obtained for intact parathyroid hormone (iPTH) and 25-hydroxyvitamin D (25OHD). Additional data were collected by a questionnaire that enquired about age, weight, height, wearing style, dietary calcium intake and sunlight exposure. Serum 25OHD concentration was measured using a precise HPLC assay. Low vitamin D status was defined as a 25OHD concentration less than 30 ng/mL. ResultsMean serum 25OHD concentration in summer was 28.4±10.4 ng/mL and 13.8±6.6 ng/mL in winter (p<0.001). 35.6% of the subjects were vitamin D insufficient in summer and 12.7% in winter (p<0.001) while 31.5% were vitamin D deficient in summer and 83.9% in winter (p<0.001). A significant increase in iPTH levels (33.1±15.9 pg/mL vs 49.6±24.3 pg/mL, p<0.001) was observed throughout the seasonal change. No significant association was found between 25OHD levels and iPTH, body mass index, age and sun exposure index (p>0.05 for all) in both seasons. ConclusionVitamin D deficiency is very prevalent in office workers even in summer time and this should be accepted as a public health problem.

Vitamin D Assessment Using Simple Questionnaires from a College Cohort Study

Vitamin D is important to the health of college students. Our objective was to measure vitamin D intake, sun exposure, skin pigmentation, and serum 25‐hydroxyvitamin D (25[OH]D) in a subset of students from the FLASH Longitudinal College Health Study at Cal Poly, San Luis Obispo, CA. Vitamin D intake and sun exposure were measured using two different tools. First, an online categorical (C) questionnaire administered by the FLASH Study including fish and milk intake, minutes in the sun on the weekdays and weekends. Second, a 28 day recall (R) questionnaire specific to vitamin D foods/supplements, and sun exposure with minutes outside and clothing worn to calculate a sun exposure index (SEI). Skin pigmentation was measured using a reflectance spectrophotometer. Serum 25(OH)D was measured at a local pathology lab. The different measurements for diet and sun exposure were each incorporated into a regression model along with average forehead skin reflectance (FSR) to predict 25(OH)D (Spring 2010, n=35). The average SEI from 11am–3pm (R), fish intake (C), and FSR were significant predictors (R2=0.39, p=0.0036). Weekend sun exposure (C), average monthly intake of vitamin D (R) and FSR were also significant predictors (R2=0.42, p=0.0005). Weekend sun exposure (C), fish intake (C), and FSR were the strongest predictors (R2=0.50, p=0.0001). Thus, simple questionnaires can be used to help determine vitamin D status.

Skin texture parameters of the dorsal hand in evaluating skin aging in China

There are various non-invasive methods in skin morphology for assessing skin aging. The use of digital photography will make it easier and more convenient. In this study, we explored some skin texture parameters for evaluating skin aging using digital image processing. Two hundred and twenty-eight subjects who lived in Sanya, China, were involved. Individual sun exposure history and other factors influencing skin aging were collected by a questionnaire. Meanwhile, we took photos of their dorsal hands. Skin images were graded according to the Beagley-Gibson system. These skin images were also processed using image analysis software. Five skin texture parameters, Angle Num., Angle Max., Angle Diff., Distance and Grids, were produced in reference to the Beagley-Gibson system. All texture parameters were significantly associated with the Beagley-Gibson score. Among the parameters, the distance between primary lines (Distance) and the value of angle formed by intersection textures (Angle Max., Angle Diff.) were positively associated with the Beagley-Gibson score. However, there was a negative correlation between the number of grids (Grids), the number of angle (Angle Num.) and the Beagley-Gibson score. These texture parameters were also correlated with factors influencing skin aging such as sun exposure, age, smoking, drinking and body mass index. In multivariate analysis, Grids and Distance were mainly affected by age. But Angle Max. and Angle Diff. were mainly affected by sun exposure. It seemed that the skin surface morphologic parameters presented in our study reflect skin aging changes to some extent and could be used to describe skin aging using digital image processing.

Abstract A79: Vitamin D status and breast cancer aggressiveness among African American and European American women in South Carolina

Abstract Background and Significance: Racial disparities exist in breast cancer, with African-American (AA) women being diagnosed with more aggressive disease and exhibiting higher mortality than their European-American (EA) counterparts. Vitamin D is of interest in breast cancer prevention and prognosis because of its ability to inhibit cell proliferation and induce apoptosis and differentiation in both normal and malignant breast cells. Circulating 25hydroxyD [25(OH)D] concentrations in humans are a measure of vitamin D status, and vary based on sun exposure, dietary intake, supplement use, skin tone, age, and body mass index [BMI = weight(kg)/height(m)2], among other factors. This study examines racial differences in vitamin D status and the association between serum 25(OH)D and clinical parameters among women diagnosed with breast cancer in South Carolina. Methods: A total of 107 women between 33 and 84 years of age and diagnosed with breast cancer in the previous five years were enrolled in the study (n=60 AA, n=47 EA). Each participant donated a blood sample, and serum 25(OH)D was measured by enzyme immunoassay. Age, BMI, clinical characteristics, and treatment were abstracted from medical records. Results: The mean (±SD) concentration of serum 25(OH)D in EA women was 29.8 ± 12.1 ng/ml while the mean concentration in AA women was 19.3 ± 10.0 ng/ml. Vitamin D deficiency (defined as serum 25(OH)D &amp;lt;20ng/ml) was much more common among AAs (60%) compared with EAs (15%). Serum 25(OH)D concentrations decreased with increasing stage of disease and were lowest among women who were triple (ER/PR/HER2) negative compared with other groups. Women who were vitamin D deficient were 8 times more likely to be diagnosed with aggressive disease (defined as regional or distant stage) as compared to women who were sufficient in vitamin D, though the confidence interval was wide, indicating imprecision of the result (OR=8.6,95%CI=1.8,41.2, after adjustment for age, race, BMI, season and months since diagnosis). Conclusions: This study corroborates other research showing racial differences in vitamin D status and provides further support for a protective role of vitamin D in breast cancer, particularly for highly aggressive disease. The prevalence of vitamin D deficiency and insufficiency was high, suggesting the need for monitoring of vitamin D levels among breast cancer patients. This work was supported by grants from the National Cancer Institute, Center to Reduce Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network (SCCDCN) [1 U01 CA114601] and the Cancer Center of the University of South Carolina. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A79.