Vitamin D Status and Its Consequences for Health in South Africa
Abstract
:1. Introduction
2. Vitamin D Status in South Africa
3. Sun Exposure and Photoprotection in Relation to Vitamin D Production in South Africa
4. Effect of Urbanisation and Diet on Vitamin D Status in South Africa
5. Association of Vitamin D Status with Diseases in South Africa
6. Vitamin D Receptor Gene (VDR) Polymorphisms and Ethnicity in South Africa
7. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Parameter | Cape Town Latitude 35° S, Altitude 0–300 m | Pretoria Latitude 26° S, Altitude 1339 m | ||
---|---|---|---|---|
Summer | Winter | Summer | Winter | |
Average hours of sunshine per day | 11 | 5 | 10 | 8 |
Ultraviolet index | 9–10 | 2–3 | 11+ | 4–6 |
Average temperature in °C, minimum/maximum | 16/26 | 7/18 | 18/28 | 5/20 |
Study Population, Sampling Frame | Age (Years) | Location (Latitude), Season of Sampling when Specified | Assay | Serum or Plasma 25(OH)D Concentration Means (Unless Specified), nmol/L | Reference (Year) |
---|---|---|---|---|---|
Children | |||||
285 Coloured (mixed race) children; community based | 1–17 | Western Township, Johannesburg (26° S), winter | Competitive protein binding | 78.0 in age 1–12 y, 58.5 in age 13–14 y, 56.8 in age 15–16 y; none <25; no difference between boys and girls | [23] (1978) |
60 Black African children; school sample | 7–12 | Rural, small urban and large urban communities near Johannesburg (26° S) | Competitive protein binding | 72.3 in rural, 77.3 in small urban, 82.8 in large urban; none <25 | [24] (1979) |
114 hospitalised Black African infants; random hospital admissions | 0–2 | Witwatersrand (26° S), throughout year | Competitive protein binding | 37.3 aged 1–24 months, no correlation with age or season; <12.5 in 7%. 19.8 aged 0–1 month, probably reflecting vitamin D status of mother | [25] (1985) |
20 Black African pre-school children; cluster sample of villages | 3–5 | Villages in Northern Transvaal, now Limpopo (24° S), end of summer | Competitive protein binding | 85.5, no difference between underweight and normal weight children | [26] (1986) |
82 Black Africans with OCA, 58 Black Africans; school sample | 6–18 | Pietersburg, Northern Province (24° S) | Radioimmunoassay | 125 in OCA Blacks, 103 in Blacks, 6–9 y; 116 in OCA Blacks, 86.3 in Blacks, 10–13 y; 90.3 in OCA Blacks, 90.8 in Blacks,14–18 y | [27] (2000) |
295 Black African children, 90 White children; bone health subcohort of Birth-to-Twenty longitudinal cohort | 10 | Johannesburg (26° S), all seasons | Chemiluminescence (DiaSorin Liaison) | 100 in Black boys, 129 in White boys, 86 in Black girls, 112 in White girls; <50 in 8% Blacks and 1% Whites; higher values in White children in summer/autumn than in winter/spring, no seasonal variation in Blacks | [28] (2011) |
Adults | |||||
43 healthy Black African women and cord blood of their babies, shortly after delivery; hospital based | 16–40 | Transkei (31° S) | Competitive protein binding | 81.8 in mothers; 171 in cord blood | [29] (1987) |
105 healthy White and 74 Black African premenopausal nurses; 50 healthy White and 65 Black African postmenopausal nurses; hospital based | 20–64 | Witwatersrand (26° S) | Competitive protein binding | Medians–65.8 in premenopausal White, 48.3 Black; 64.5 in postmenopausal White, 67.5 Black | [30] (1997) |
216 requests for vitamin D testing (39% with suspected osteoporosis); hospital based | All ages, peaks at 2 and 64 | Western Cape (32° S), all seasons | Competitive protein binding | Medians–48.3 (range 5.5–106); <45 in 41%; no seasonal effect on level | [31] (2009) |
658 rural healthy Black African women, 603 urban healthy Black African women; random selection from Prospective Urban and Rural Epidemiology Study or community based | >35 | North West Province (27° S), rural and urban seasonally matched | Roche Eledsys 2010 COBAS system | Levels decreased with age in both rural and urban women from about 78 at <50 y to about 65 at >70 y; levels lower in urban than in rural women, aged 50–70 y | [32] (2011) |
373 Black Africans, 344 Asian/Indians; cohort from Birth-to-Twenty longitudinal study | Mean 42 | Johannesburg-Soweto (26° S), all seasons | HPLC | 70.9 Blacks, 41.8 Asian/Indian; <30 3% Blacks and 13% Asian/Indians; females lower than males in both groups; highest level in autumn | [33] (2013) |
291 healthy urban Black African women; random selection from Prospective Urban and Rural Epidemiology Study or community based | >47 (mean 57.6) | North West Province (27° S) | Roche Elecsys 2010 COBAS system | 65; those with levels <75 two-times more likely to have higher systolic blood pressure than those with >75 (151 vs. 146 mmHg) | [34] (2013) |
368 healthy Black Africans and 347 healthy Asian/Indians; random selection from Birth-to-Twenty longitudinal study | 18–65 | Johannesburg (26° S) | HPLC | 58.3 in Black females, 72.7 in Black males, 35.7 in Asian/Indian females, 45.4 in Asian/Indian males | [35] (2014) |
371 healthy Black Africans and 343 healthy Asian/Indians; random selection from Birth-to-Twenty longitudinal study | 18–65 | Johannesburg (26° S) | HPLC | 56.8 in Black females, 72.4 in Black males, 32.4 in Asian/Indian females, 43.9 in Asian/Indian males; <30 in 5% Blacks and 28.6% Asian/Indians; levels 40%–60% higher in autumn than in winter/spring; little 25(OH)D2 | [36] (2014) |
502 Black Africans; population sample from Modelling of the Epidemiologic Transition Study | 25–45 (mean 33.4) | Cape Town (34° S), winter and summer months | LC-MS/MS | 59.3; <30 in 6.6%, >50 in 65.9%; negative correlation of 25(OH)D level with distance from the equator (by comparing levels in Blacks living at latitudes 41° N, 17° N, 6° N, 4° S and Cape Town) | [37] (2014) |
50 healthy Black Africans, 50 healthy Coloured (Cape mixed); community based longitudinal study | 18–24 | Cape Town (34° S), winter and summer months | Chemiluminescence (DiaSorin, Liaison) | Medians: 72.6 Black, 65.5 Coloured in summer; 45.5 Black, 43.8 Coloured in winter | [38] (2015) |
Elderly | |||||
232 patients with femoral neck fractures, ethnicity not specified; hospital admissions | Mean 72.7 | Johannesburg (26° S), throughout year | Competitive protein binding | 44.3 throughout year; 51 in summer/autumn, 38.1 in winter and spring; <25 in 17% subjects in winter/spring | [39] (1978) |
60 females living in old-age homes, ethnicity not specified | Mean 80 | Pretoria (26° S), winter | Not specified | 32 | [40] (1991) |
173 non-institutionalised Coloured (mixed race), 52% women; population sample | 65–92 (mean 73.7) | Cape Town (34° S), late winter | Not specified | 37; <25 in 17% | [41] (1996) |
Category | Disease/Study Groups | Assoc 1 | Study Type | Location | Population | Sample Size | Age Group | Gender | Reference |
---|---|---|---|---|---|---|---|---|---|
Bone | Fractures | Yes | longitudinal | Gauteng | NA | 20, 20 | 6–29 y | M & F | [59] |
Bone | Rickets | Yes | cross-sectional | KwaZulu-Natal | Black African | 37 | 1–12 y | M & F | [60] |
Bone | Bone mineral density | Yes | cross-sectional | North-West | Black African | 658 | >45 y | F | [32] |
Bone | Growth stunting | Yes | cross-sectional | Northern Cape | NA | 150 | 2–5 y | M & F | [57] |
Bone | Rickets | No | cross-sectional | Gauteng | Black African | 114 | <2 y | M & F | [25] |
Bone | Metabolic bone disease | No | cross-sectional | Gauteng | Black African | 26 | 16–19 y | M | [61] |
Bone | Bone mineral density | No | cross-sectional | Gauteng | Black & Asian-Indian | 371, 343 | 18–65 y | M & F | [35] |
Bone | Under weight vs. normal weight | No | case-control | Limpopo | Black African | 145 | 3–5 y | M & F | [22] |
Bone/ID | BMD in HIV uninfected vs. HIV high CD4 vs. HIV low CD4 count | No | case-control | Gauteng | Black African | 98, 74, 75 | ≥18 y | F | [62] |
ID | Schistosomiasis (PZQ vs. PZQ + vitamin D vs. vitamin D vs. placebo) | Yes 2 | RCT | Mozambique border | NA | 14, 16, 14, 15 | 14–18 y | M | [63] |
ID | TB-Meningitis | Yes 3 | case-control | Western Cape | Black & Coloured | 42, 147 | 0–13 y | M & F | [64] |
ID | HIV replication (Summer vs. winter vs. winter + vitamin D) | Yes | longitudinal | Western Cape | Black African | 30 | 18–24 y | M & F | [38] |
ID | TB HIV (TB vs. HIV vs. TB-HIV vs. OD) | Yes | case-control | Western Cape | Black African | 93, 75, 99, 103 | ≥18 y | M & F | [65] |
ID | HIV-Cryptococcal Meningitis vs. HIV | No 4 | case-control | Western Cape | NA | 150, 150 | ≥21 y | M & F | [66] |
ID | HIV ART initiation | NA 5 | cross-sectional | Gauteng/KWN | NA | 270 | ≥18 y | M & F | [67] |
ID | HIV ART initiation | NA 5 | cross-sectional | Gauteng/KWN | NA | 270 | ≥18 y | M & F | [68] |
ID | Paradoxical TB-HIV IRIS vs TB-HIV no IRIS | No | case-control | KwaZulu-Natal | Black African | 11, 11 | 24–50 y | M & F | [69] |
ID | ART-associated TB vs HIV+TB- | No | case-control | KwaZulu-Natal | Black African | 18, 38 | 23–57 y | M & F | [69] |
NCD | Cardiovascular disease (blood pressure and pulse) | Yes | cross-sectional | North-West | Black African | 291 | >47 y | F | [34] |
NCD | Metabolic syndrome | No | cross-sectional | Gauteng | Black & Asian-Indian | 374, 350 | 18–65 y | M & F | [33] |
NCD | Obesity (total body fat, fat distribution) | No | cross-sectional | Gauteng | Black & Asian-Indian | 371, 343 | 18–65 y | M & F | [36] |
Nutrition | Alzheimer’s zinc deficiency (Zn vs. Zn ± vitamin A ± vitamin D) | Yes 6 | RCT | Western Cape | NA | 70/group | 55 y | M | [70] |
Nutrition | Alcohol use disorders vs. matched controls | Yes | cross-sectional | Western Cape | Mixed ancestry | 81, 81 | 12–16 y | M & F | [71] |
SNP (rs) | Study Population; Gender when Specified | Factor Investigated | Study Design | Median/Mean Age, Years (Range) | Association | Reference |
---|---|---|---|---|---|---|
FokI (rs2544037) (rs10783219) (rs10735810) TaqI (rs731236) | 22 male, 28 female Cape mixed; 26 male, 24 female Black Africans (Zhosa) | Determinants of 25(OH)D status, before and after vitamin D supplementation | Longitudinal | (18–24) | FokI (rs10735810) “AG” contributed to lower 25(OH)D, and lower 25(OH)D in winter and post-supplementation, while “AA” contributed to higher 25(OH)D, in a linear model incorporating UVB exposure, skin pigmentation, ethnicity, age and sex | [38] |
ApaI (rs7975232) TaqI (rs731236) | 264 Black Africans, 247 Whites, 194 Asian-Indians | Ethnicity | Retrospective cross-sectional cohort of healthy male and female blood donors | NA | Higher ApaI “AA” and TaqI “TT” in Blacks than Whites or Asian-Indians; no difference between Whites and Asian-Indians. Higher frequency of TaqI “T” may contribute to lower incidence of osteoporosis in Blacks | [85] |
FokI (rs2228570) BsmI (rs1544410) ApaI (rs7975232) TaqI (rs731236) | 95 Black Africans (Venda) with TB, 117 ethnicity matched controls | TB | Case-control | NA | No independent SNP association; FokI-BsmI-ApaI-TaqI haplotype “F-b-A-T” (C-G-T-T) protects | [86] |
FokI (rs2228570) ApaI (rs7975232) TaqI (rs731236) | All Colored: 249 TB cases, 352 ethnicity matched controls, 220 TB cases converting from positive to negative | TB and chemotherapy for TB | Case-control for TB; longitudinal for TB conversion | (18–65) | No association of VDR allele, genotype, haplotype or diplotype with TB. Quicker response to TB chemotherapy in ApaI “AA” (TT) vs. “aa” (GG), in TaqI “Tt” (TC) vs. “tt” (CC) and in TaqI “TT” (TT) vs. “tt” (CC) | [87] |
ApaI (rs7975232) TaqI (rs731236) | 15 male, 15 female CAU (North America); 15 male, 15 female YRI (Nigeria); 16 male, 16 female Black Africans (Venda) with TB together with 12 male and 17 female healthy Black African controls | Ethnicity, TB, and DNA methylation of the VDR 3’ region CGI 1060 | Ethnicity; case-control for TB | CAU 32 (22–44), YRI unknown, TB cases 38 (18–62) TB controls 34 (21–62) | Methylation variable positions in 3’ end of VDR distinguish ethnicity and TB status. Higher regional methylation in TaqI “TC/CC” than “TT” in YRI and Venda, but not in CAU | [88] |
FokI (rs10735810 merged into rs2228570) | 296 Black Africans with RSV, 113 Black African controls | RSV-related disease | Case-control | Cases 3.0 months, controls 3.5 months | FokI “C” frequency higher in Black South Africans than European, Asian and Japanese populations. “CT” and “T” predispose to RSV disease, while “CC” protects | [89] |
FokI (rs2228570) | 40 healthy Black Africans, 20 healthy Whites | VDR expression and VDR function, considering ethnicity and 25(OH)D levels | Cross-sectional cohort of male and female blood donors | 35 (17–65) | Higher frequency FokI “CC” genotype and VDR protein in Blacks than Whites, but less VDR mRNA and CAMP mRNA. CAMP mRNA higher in FokI “CT/TT” genotypes than “CC”. Circulating 25(OH)D levels ≥50 nmol/L, and comparable between Blacks and Whites. Different effects on CAMP and CYP24A1 expression in Whites and Blacks on supplementation with 1,25(OH)2D | [90] |
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Norval, M.; Coussens, A.K.; Wilkinson, R.J.; Bornman, L.; Lucas, R.M.; Wright, C.Y. Vitamin D Status and Its Consequences for Health in South Africa. Int. J. Environ. Res. Public Health 2016, 13, 1019. https://doi.org/10.3390/ijerph13101019
Norval M, Coussens AK, Wilkinson RJ, Bornman L, Lucas RM, Wright CY. Vitamin D Status and Its Consequences for Health in South Africa. International Journal of Environmental Research and Public Health. 2016; 13(10):1019. https://doi.org/10.3390/ijerph13101019
Chicago/Turabian StyleNorval, Mary, Anna K. Coussens, Robert J. Wilkinson, Liza Bornman, Robyn M. Lucas, and Caradee Y. Wright. 2016. "Vitamin D Status and Its Consequences for Health in South Africa" International Journal of Environmental Research and Public Health 13, no. 10: 1019. https://doi.org/10.3390/ijerph13101019