Residential Greenness, Lifestyle, and Vitamin D: A Longitudinal Cohort of South Asian Origin and Caucasian Ethnicity Women Living in the South of the UK.

The global population is at risk of vitamin D deficiency due to low exposure to sunlight and low intake of the vitamin through diet. The aim of this study was to investigate in women the association between vitamin D status and parathyroid hormone (PTH), ultraviolet radiation, lifestyle, ethnicity, social conditions, and residential greenness. A 1-year longitudinal study assessed vitamin D status in 309 women living at latitude 51°14' N. Blood samples were taken four times throughout the year for analysis of 25(OH)D and serum PTH concentration. After each seasonal visit, the individuals completed 4-day diet diaries and used two dosimeter badges for 1 week to estimate weekly UVR exposure. A questionnaire was applied to provide information about lifestyle and their ethnicity. Residential greenness was measured by Normalized Difference Vegetation Index (NDVI), within a 1000 m radius around each participant's home address. Women living in greener spaces were more likely to have improved vitamin D status (RR: 1.51; 95%CI: 1.13-2.02), as well as those who were more exposed to UVR (RR: 2.05; 95%CI: 1.44-2.92). Our results provide an insight into the connection between residential greenness, lifestyle, and vitamin D status comparing two ethnicities in a country with a temperate climate and with a high degree of urbanization.

Clima, estilo de vida e áreas verdes em cidades: análises geoepidemiológicas sobre status de vitamina D em mulheres / Climate, lifestyle and green areas in cities: geoepidemiological analyzes on vitamin D status in women

Introdução: Associada com uma considerável quantidade de doenças crônicas, agudas e mais recentemente, a Covid 19, a deficiência de vitamina D tem se tornado cada vez mais prevalente até em regiões de baixa latitude. Objetivo geral: Identificar e caracterizar a associação entre clima, estilo de vida e áreas verdes com os status de vitamina D em mulheres. Objetivos específicos: Avaliar a associação entre concentrações séricas de 25(OH)D e fatores relacionados ao estilo de vida em uma amostra de mulheres brasileiras que vivem na latitude 21º 80' S. Analisar a associação entre verde residencial em áreas urbanas e concentrações séricas de 25(OH)D em moradoras de uma cidade brasileira interiorana de médio porte e de clima tropical. Analisar a associação entre verde residencial, estilo de vida e concentrações séricas de 25(OH)D em moradoras de cidades de clima temperado ao sul da Inglaterra. Método: Foram realizados dois estudos epidemiológicos que analisaram a influência da dieta e exposição à luz solar no status de vitamina D. Idade, variáveis antropométricas, cor da pele e estado pós-menopausa foram medidos como potenciais fatores de confusão. O estudo transversal foi realizado com 101 mulheres com 35 anos ou mais que avaliou a associação entre a concentração sérica de 25(OH)D e a exposição à radiação ultravioleta, estilo de vida e depressão. O estudo longitudinal de 1 ano avaliou o status de vitamina D em 365 mulheres caucasianas e asiáticas, na pré-menopausa e pós-menopausa, residentes na região sul do Reino Unido. Como indicador da variável áreas verdes, foi calculado o Índice de Vegetação por Diferença Normalizada. Foram usados modelos de regressão múltipla e logística para analisar a associação entre as variáveis, além de testes não paramétricos. Os estudos resultaram em três artigos que estão na presente tese. Resultados: No primeiro artigo, no estudo transversal, mulheres mais velhas tiveram uma concentração significativamente maior de 25(OH)D do que as mulheres mais jovens (p = 0,013), bem como maior exposição à RUV (p = 0,01) e menor IMC (p = 0,005). Esses achados são independentes de outros fatores de confusão medidos. No segundo artigo, observou-se uma associacao positiva estatisticamente significativa entre a exposicao ao indice de vegetacao circundante residencial abaixo da mediana e a prevalencia de niveis insuficientes de 25(HO)D (P=0,03).No terceiro artigo, no estudo de coorte, as participantes que viviam em áreas mais verdes eram mais propensas a ter status de vitamina D melhorado (RR: 1,51, IC 95%: 1,13- 2,02), assim como, as que eram mais expostas à radiação ultravioleta (RR: 2,05, IC 95%: 1,44 - 2,92). Contudo, no modelo totalmente ajustado, as variáveis etnia e hormônio paratireóideo permaneceram significantes, p < 0,001 e p = 0,003. Conclusão: Foram encontradas associações entre vitamina D, estilo de vida, saúde mental e áreas verdes importantes para um panejamento urbano e social de incentivo a atividades ao ar livre. Contudo, uma análise de mediação que elucide como as áreas verdes contribuem para maiores níveis de vitamina D através do tempo de exposição à luz solar é necessário.

Introduction: Associated with a considerable amount of chronic and acute diseases and more recently, Covid 19, vitamin D deficiency has become increasingly prevalent even in low latitude regions. General objective: To identify and characterize the association between climate, lifestyle and green areas with vitamin D status in women. Specific objectives: To evaluate the association between serum concentrations of 25(OH)D and factors related to lifestyle in a sample of Brazilian women living at latitude 21º 80' S. To analyze the association between residential green in urban areas and serum concentrations of 25(OH)D in residents of a medium-sized country town in Brazil with a tropical climate. To analyze the association between residential greenery, lifestyle and serum concentrations of 25(OH)D in residents of temperate cities in the south of England. Method: Two epidemiological studies were performed that analyzed the influence of diet and sunlight exposure on vitamin D status. Age, anthropometric variables, skin color and postmenopausal status were measured as potential confounders. A cross-sectional study was carried out with 101 women aged 35 years or older that evaluated the association between serum 25(OH)D concentration and exposure to ultraviolet radiation, lifestyle and depression. The 1-year longitudinal study assessed the vitamin D status of 365 premenopausal and postmenopausal Caucasian and Asian women residing in the southern part of the UK. As an indicator of the green areas variable, the Vegetation Index by Normalized Difference was calculated. Multiple and logistic regression models were used to analyze the association between variables, in addition to non-parametric tests. The studies resulted in three articles that are in this thesis. Results: In the first article, in the cross-sectional study, older women had a significantly higher concentration of 25(OH)D than younger women (p = 0.013), as well as greater exposure to UVR (p = 0.01) and lower BMI (p = 0.005). These findings are independent of other measured confounders. In the second article, a statistically significant positive association was observed between exposure to the surrounding residential vegetation index below the median and the prevalence of insufficient levels of 25(HO)D (P=0.03). cohort, participants who lived in greener areas were more likely to have improved vitamin D status (RR: 1.51, 95% CI: 1.13-2.02), as were those who were more exposed to ultraviolet radiation (RR: 2.05, 95% CI: 1.44 - 2.92). However, in the fully adjusted model, the variables ethnicity and parathyroid hormone remained significant, p < 0.001 and p = 0.003. Conclusion: Association was found between vitamin D, lifestyle, mental health and important green areas for urban and social planning to encourage outdoor activities. However, a mediation analysis that elucidates how green areas contribute to higher levels of vitamin D through exposure time to sunlight is needed.

Association between vitamin D status and lifestyle factors in Brazilian women: Implications of Sun Exposure Levels, Diet, and Health.

Background: Vitamin D deficiency has been documented to be prevalent, even in low latitude regions; and this may be related to sun exposure behaviors. The aim of the current study was to assess the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and lifestyle-related factors in a sample of Brazilian women living at latitude 21º 8' S. Methods: A cross-sectional study was undertaken in 101 women aged 35 years or older in July 2019 to assess the association between 25(OH)D concentration and level of exposure to ultraviolet radiation (UVR), smoking habits, alcohol consumption, and physical activity levels. Age, body mass index (BMI), and postmenopausal status were investigated. Findings: According to the slope coefficient for individual daily UVR levels, the concentration of 25(OH)D increased by 5 nmol / L for each extra Standard Erythema Dose of UVR, regardless of age and BMI (p < 0·001). Postmenopausal women had a significantly higher mean concentration of 25(OH)D (p = 0·01), higher UVR exposure (p = 0·01) and lower BMI (p = 0·005) compared with younger women, independent of other confounders including smoking, alcohol, occupation and physical activity. Interpretation: Although postmenopausal women from Brazil had higher mean concentrations of 25(OH)D than younger women, more studies are necessary to understand how sun exposure and lifestyle variables interfere with these levels. These findings have important public health implications since they suggest that vitamin D deficiency in older age is not inevitable. Funding: This study was funded by an award received by Universities Global Partnership Network - UGPN. KVSS and SLO receive scholarship from CAPES, Brazilian Ministry of Education. HR receives a productivity grant from CNPq.

Does Vitamin D play a role in the management of Covid-19 in Brazil?

The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.

Does vitamin D play a role in the management of Covid-19 in Brazil?

ABSTRACT The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.