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Review

Insufficient Sun Exposure Has Become a Real Public Health Problem

1
Institute of Environmental Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
2
School of Population and Global Health, The University of Western Australia, Perth 6009, Australia
3
Department of Chemistry and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40506, USA
4
Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
5
Department of Dermatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Clinical & Experimental Sciences, University of Southampton Medical School and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
7
Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
8
Telethon Kids Institute, University of Western Australia, Perth 6872, Australia
9
Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
10
Department of Pharmacy, University of Copenhagen, DK-2100 Copenhagen, Denmark
11
Department of Clinical Science and Education, Karolinska Institute, 171 77 Stockholm, Sweden
12
College of Medicine and Health, University of Exeter Medical School, Exeter EX1 2LU, UK
13
Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02115, USA
14
Centre for Inflammation Research, University of Edinburgh, Edinburgh EH16 4SB, UK
15
St John’s Institute of Dermatology, King’s College London, London SE1 9RT, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(14), 5014; https://doi.org/10.3390/ijerph17145014
Received: 2 June 2020 / Revised: 1 July 2020 / Accepted: 4 July 2020 / Published: 13 July 2020
This article aims to alert the medical community and public health authorities to accumulating evidence on health benefits from sun exposure, which suggests that insufficient sun exposure is a significant public health problem. Studies in the past decade indicate that insufficient sun exposure may be responsible for 340,000 deaths in the United States and 480,000 deaths in Europe per year, and an increased incidence of breast cancer, colorectal cancer, hypertension, cardiovascular disease, metabolic syndrome, multiple sclerosis, Alzheimer’s disease, autism, asthma, type 1 diabetes and myopia. Vitamin D has long been considered the principal mediator of beneficial effects of sun exposure. However, oral vitamin D supplementation has not been convincingly shown to prevent the above conditions; thus, serum 25(OH)D as an indicator of vitamin D status may be a proxy for and not a mediator of beneficial effects of sun exposure. New candidate mechanisms include the release of nitric oxide from the skin and direct effects of ultraviolet radiation (UVR) on peripheral blood cells. Collectively, this evidence indicates it would be wise for people living outside the tropics to ensure they expose their skin sufficiently to the sun. To minimize the harms of excessive sun exposure, great care must be taken to avoid sunburn, and sun exposure during high ambient UVR seasons should be obtained incrementally at not more than 5–30 min a day (depending on skin type and UV index), in season-appropriate clothing and with eyes closed or protected by sunglasses that filter UVR. View Full-Text
Keywords: disease prevention; UV radiation; sun exposure; vitamin D; nitric oxide disease prevention; UV radiation; sun exposure; vitamin D; nitric oxide
MDPI and ACS Style

Alfredsson, L.; Armstrong, B.K.; Butterfield, D.A.; Chowdhury, R.; de Gruijl, F.R.; Feelisch, M.; Garland, C.F.; Hart, P.H.; Hoel, D.G.; Jacobsen, R.; Lindqvist, P.G.; Llewellyn, D.J.; Tiemeier, H.; Weller, R.B.; Young, A.R. Insufficient Sun Exposure Has Become a Real Public Health Problem. Int. J. Environ. Res. Public Health 2020, 17, 5014. https://doi.org/10.3390/ijerph17145014

AMA Style

Alfredsson L, Armstrong BK, Butterfield DA, Chowdhury R, de Gruijl FR, Feelisch M, Garland CF, Hart PH, Hoel DG, Jacobsen R, Lindqvist PG, Llewellyn DJ, Tiemeier H, Weller RB, Young AR. Insufficient Sun Exposure Has Become a Real Public Health Problem. International Journal of Environmental Research and Public Health. 2020; 17(14):5014. https://doi.org/10.3390/ijerph17145014

Chicago/Turabian Style

Alfredsson, Lars, Bruce K. Armstrong, D. A. Butterfield, Rajiv Chowdhury, Frank R. de Gruijl, Martin Feelisch, Cedric F. Garland, Prue H. Hart, David G. Hoel, Ramune Jacobsen, Pelle G. Lindqvist, David J. Llewellyn, Henning Tiemeier, Richard B. Weller, and Antony R. Young. 2020. "Insufficient Sun Exposure Has Become a Real Public Health Problem" International Journal of Environmental Research and Public Health 17, no. 14: 5014. https://doi.org/10.3390/ijerph17145014

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