Abstract
OBJECTIVES: Aboriginal peoples affected by a nutrition transition and living at high latitudes are among the ethnic groups most at risk of vitamin D deficiency. The objectives of this study were to determine the prevalence of meeting predefined cut-off concentrations of vitamin D and to examine associated factors among James Bay Cree aged ≥15 years.
METHODS: A cross-sectional study was conducted between the months of May and September from 2005 to 2009. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by radioimmunoassay. Anthropometrics were measured and additional information on socio-demographic characteristics, lifestyle and dietary habits was obtained using questionnaires. A logistic regression model predicting vitamin D insufficiency (<50 nmol/L) included known covariates.
RESULTS: Data were obtained from 944 Cree (406 men (43%); mean age 37.4 years), with an effective participation rate of 49% among women and 41% among men. Mean serum 25(OH)D concentrations (nmol/L) by gender were 52.9 (95% CI 51.4-54.5) in men and 47.5 (95% CI 46.2-48.9) in women, and by age group were 46.0 (95% CI 44.9–48.9) in those 15-39 years and 59.6 (95% CI 57.9-61.4) in those ≥40 years of age. Overall, 5.8%, 42.6%, 40.0%, and 11.7% of the participants had 25(OH)D concentrations <30, 30-49.9, 50-74.9 and ≥75 nmol/L, respectively. Female gender, obesity, younger age, spring, low fish and milk intake, and low vigorous physical activity predicted vitamin D insufficiency (all p<0.05).
CONCLUSION: The vitamin D status in Eastern James Bay Cree is suboptimal with nearly half of the population having insufficient concentrations for optimum bone health.
Key Words: Vitamin D, vitamin D deficiency, prevalence, Natives
Résumé
OBJECTIFS: Les Autochtones en transition nutritionnelle qui vivent sous les latitudes élevées sont parmi les groupes ethniques les plus à risque de carences en vitamine D. Nous avons voulu déterminer la prévalence du respect des concentrations-limites prédéfinies en vitamine D et examiner les facteurs associés chez les Cris de la baie James âgés de ≥15 ans.
MÉTHODE: Nous avons mené une étude transversale entre les mois de mai et de septembre de 2005 à 2009. Les concentrations sériques de 25- hydroxyvitamine D (25-OH-D) ont été mesurées par radio-immuno-essai. Nous avons pris des mesures anthropométriques et obtenu de l’information supplémentaire sur les caractéristiques sociodémographiques, le mode de vie et les habitudes alimentaires à l’aide de questionnaires. Un modèle de régression logistique prédisant l’insuffisance en vitamine D (<50 nmol/L) englobait les covariables connues.
RÉSULTATS: Nous avons recueilli des données auprès de 944 Cris (406 hommes (43 %); âge moyen de 37,4 ans) avec un taux de participation réel de 49 % chez les femmes et de 41 % chez les hommes. Les concentrations sériques moyennes de 25-OH-D (nmol/L) selon le sexe étaient de 52,9 (IC de 95 % 51,4-54,5) chez les hommes et de 47,5 (IC de 95 % 46,2-48,9) chez les femmes; par groupe d’âge, elles étaient de 46,0 (IC de 95 % 44,9-48,9) chez les 15-39 ans et de 59,6 (IC de 95 % 57,9-61,4) chez les ≥40 ans. Globalement, 5,8 %, 42,6 %, 40,0 % et 11,7 % des participants avaient des concentrations de 25-OH-D <30, 30-49,9, 50-74,9 et ≥75 nmol/L, respectivement. Le sexe féminin, l’obésité, la jeunesse, le printemps, les faibles apports en poisson et en lait et les faibles taux d’activité physique vigoureuse étaient des prédicteurs de carence en vitamine D (p<0,05 dans tous les cas).
CONCLUSIONS: Le statut en vitamine D des Cris de l’Est de la baie James est sous-optimal; près de la moitié de la population en possède des concentrations insuffisantes à une santé osseuse optimale.
Mots Clés: vitamine D, carence en vitamine D, prévalence, population d’origine amérindienne
Footnotes
Sources of support: Niskamoon Corporation, Cree Board of Health and Social Services of James Bay, Centre de Recherche du CHU de Québec, Canadian Institutes of Health Research.
Acknowledgements: This scientific communication is a report from the Nituuchischaayihtitaau Aschii: Multi-Community Environment-and-Health Longitudinal Study in Iiyiyiu Aschii supported by the Cree people of northern Québec, the Cree First Nations and the Cree Board of Health and Social Services of James Bay through financial contributions from Niskamoon Corporation.
Conflict of Interest: None to declare.
References
- 1.Ross AC. The 2011 report on dietary reference intakes for calcium and vitamin D. Public Health Nutr. 2011;14(5):938–39. doi: 10.1017/S1368980011000565. [DOI] [PubMed] [Google Scholar]
- 2.Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporosis International. 2009;20(11):1807–20. doi: 10.1007/s00198-009-0954-6. [DOI] [PubMed] [Google Scholar]
- 3.Lips P. J Steroid Biochemistry and Molecular Biology. 2010. Worldwide status of vitamin D nutrition; pp. 297–300. [DOI] [PubMed] [Google Scholar]
- 4.Langlois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S. Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2010;21(1):47–55. [PubMed] [Google Scholar]
- 5.Weiler HA, Leslie WD, Krahn J, Steiman PW, Metge CJ. Canadian Aboriginal women have a higher prevalence of vitamin D deficiency than non- Aboriginal women despite similar dietary vitamin D intakes. J Nutr. 2007;137(2):461–65. doi: 10.1093/jn/137.2.461. [DOI] [PubMed] [Google Scholar]
- 6.Del Gobbo LC, Song Y, Dannenbaum DA, Dewailly E, Egeland GM. Serum 25-hydroxyvitamin D is not associated with insulin resistance or beta cell function in Canadian Cree. J Nutr. 2011;141(2):290–95. doi: 10.3945/jn.110.129619. [DOI] [PubMed] [Google Scholar]
- 7.Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81. doi: 10.1056/NEJMra070553. [DOI] [PubMed] [Google Scholar]
- 8.Chen TC, Chimeh F, Lu Z, Mathieu J, Person KS, Zhang A, et al. Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochemistry and Biophysics. 2007;460(2):213–17. doi: 10.1016/j.abb.2006.12.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Greene-Finestone LS, Berger C, de Groh M, Hanley DA, Hidiroglou N, Sarafin K e al. 25-Hydroxyvitamin D in Canadian adults: Biological, environmental, and behavioral correlates. Osteoporosis International. 2011;22(5):1389–99. doi: 10.1007/s00198-010-1362-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Pearce S. H., Cheetham T. D. Diagnosis and management of vitamin D deficiency. BMJ. 2010;340(jan11 1):b5664–b5664. doi: 10.1136/bmj.b5664. [DOI] [PubMed] [Google Scholar]
- 11.Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 Dietary Reference Intakes for Calcium and Vitamin D: What dietetics practitioners need to know. J Am Diet Assoc. 2011;111(4):524–27. doi: 10.1016/j.jada.2011.01.004. [DOI] [PubMed] [Google Scholar]
- 12.CMAJ. 2010.
- 13.Engelsen O. The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients. 2010;2(5):482–95. doi: 10.3390/nu2050482. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Whiting SJ, Langlois KA, Vatanparast H, Greene-Finestone LS. The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: An examination in children and adults with and without supplement use. Am J Clin Nutr. 2011;94(1):128–35. doi: 10.3945/ajcn.111.013268. [DOI] [PubMed] [Google Scholar]
- 15.Dewailly E, Blanchet C, Gingras S, Lemieux S, Holub BJ. Cardiovascular disease risk factors and n-3 fatty acid status in the adult population of James Bay Cree. Am J Clin Nutr. 2002;76(1):85–92. doi: 10.1093/ajcn/76.1.85. [DOI] [PubMed] [Google Scholar]
- 16.Berkes F, Farkas CS. Eastern James Bay Cree Indians — Changing patterns of wild food use and nutrition. Ecol Food Nutr. 1978;7(3):155–72. doi: 10.1080/03670244.1978.9990526. [DOI] [Google Scholar]
- 17.Bonnier-Viger Y, Dewailly E, Egeland G, Nieboer E, Pereg D. Environmental Health Study: Technical Report of Mistissini. Chisasibi, QC: Cree Board of Health and Social Services of James Bay; 2007. [Google Scholar]
- 18.Gagnon C, Baillargeon JP, Desmarais G, Fink GD. Prevalence and predictors of vitamin D insufficiency in women of reproductive age living in northern latitude. Eur J Endocrinology. 2010;163(5):819–24. doi: 10.1530/EJE-10-0441. [DOI] [PubMed] [Google Scholar]
- 19.Genuis SJ, Schwalfenberg GK, Hiltz MN, Vaselenak SA. Vitamin D status of clinical practice populations at higher latitudes: Analysis and applications. Int J Environ Res Public Health. 2009;6(1):151–73. doi: 10.3390/ijerph6010151. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Mai XM, Chen Y, Camargo CA, Jr., Langhammer A. Cross-sectional and prospective cohort study of serum 25-hydroxyvitamin D level and obesity in adults: The HUNT Study. Am J Epidemiol. 2012;175(10):1029–36. doi: 10.1093/aje/kwr456. [DOI] [PubMed] [Google Scholar]
- 21.PLOS ONE. 2011.
- 22.Gagnon C, Baillargeon JP, Desmarais G, Fink GD. Prevalence and predictors of vitamin D insufficiency in women of reproductive age living in northern latitude. Eur J Endocrinology. 2010;163(5):819–24. doi: 10.1530/EJE-10-0441. [DOI] [PubMed] [Google Scholar]
- 23.Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, et al. Lancet. 2006. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: A longitudinal study; pp. 36–43. [DOI] [PubMed] [Google Scholar]
- 24.Stene LC, Ulriksen J, Magnus P, Joner G. Use of cod liver oil during pregnancy associated with lower risk of Type I diabetes in the offspring. Diabetologia. 2000;43(9):1093–98. doi: 10.1007/s001250051499. [DOI] [PubMed] [Google Scholar]
- 25.Shenoy SD, Swift P, Cody D, Iqbal J. Maternal vitamin D deficiency, refractory neonatal hypocalcaemia, and nutritional rickets. Arch Dis Child. 2005;90(4):437–38. doi: 10.1136/adc.2004.065268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985;76(4):1536–38. doi: 10.1172/JCI112134. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Am J Clin Nutr. 1995.
- 28.Willows ND. Determinants of healthy eating in Aboriginal peoples in Canada: The current state of knowledge and research gaps. Can J Public Health. 2005;96(Suppl3):32–36. [PubMed] [Google Scholar]
- 29.Engelsen O, Brustad M, Aksnes L, Lund E. Daily duration of vitamin D synthesis in human skin with relation to latitude, total ozone, altitude, ground cover, aerosols and cloud thickness. Photochemistry and Photobiology. 2005;81(6):1287–90. doi: 10.1562/2004-11-19-RN-375. [DOI] [PubMed] [Google Scholar]
- 30.Caron-Jobin M, Morisset AS, Tremblay A, Huot C, Legare D, Tchernof A. Elevated serum 25(OH)D concentrations, vitamin D, and calcium intakes are associated with reduced adipocyte size in women. Obesity (Silver Spring) 2011;19(7):1335–41. doi: 10.1038/oby.2011.90. [DOI] [PubMed] [Google Scholar]
- 31.Mark S. Vitamin D status and recommendations to improve vitamin D status in Canadian youth. Appl Physiol Nutr Metab. 2010;35(5):718. doi: 10.1139/H10-054. [DOI] [PubMed] [Google Scholar]
- 32.Bertrand KA, Giovannucci E, Liu Y, Malspeis S, Eliassen AH, Wu K, et al. Determinants of plasma 25-hydroxyvitamin D and development of prediction models in three US cohorts. Br J Nutr. 2012;108(10):1889–96. doi: 10.1017/S0007114511007409. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S. Vitamin D and gestational diabetes: A systematic review and meta-analysis. Eur J Int Med. 2012;23(5):465–69. doi: 10.1016/j.ejim.2012.01.007. [DOI] [PubMed] [Google Scholar]
- 34.Haugen M, Brantsaeter AL, Trogstad L, Alexander J, Roth C, Magnus P, et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009;20(5):720–26. doi: 10.1097/EDE.0b013e3181a70f08. [DOI] [PubMed] [Google Scholar]
- 35.Borges MC, Martini LA, Rogero MM. Current perspectives on vitamin D, immune system, and chronic diseases. Nutrition. 2011;27(4):399–404. doi: 10.1016/j.nut.2010.07.022. [DOI] [PubMed] [Google Scholar]